Bulletin of the North Carolina Board of Health

library of
(El}e University of XTortl] Carolina
COLLECTION OF
NORTH CAROLINIANA
ENDOWED B Y
JOHN SPRUNT HILL
of the class of 1889
. IS
This book must not
be taken from the
Library building.
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Form No. 471
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, X. C.
Geo. G. Thomas, M.D., Pres.,Wilmington. C. J. O'Hagan, M. D Greenville.
S. AVesteay Battle, M. D...Asheville. J. L. Nicholson, M. D Riehlands.
Henry W. Lewis, M. D Jackson. Albeet Anderson, M. D- Wilson.
Henry H. Dodson, M. D Milton. A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. APRIL, 1900. No. 1.
Election of County Superintendents
of Health.
We beg leave to call the attention of
all Boards of County Commissioners to
the fact that they are required by the law
as amended by the General Assembly of
1897 to elect a County Superintendent of
Health at their meeting in May. The
Amended law reads: "From this number
(all registered physicians resident in the
county) one physician shall be chosen by
the Board ofCommissioners ofeach county
annually on the first Monday in May of
each year to serve with the title of
Superintendent of Health." We trust
that this important matter will not be
overlooked.
Politics ami Small-Pox.
The inauguration of the political cam-paign
brings to our mind the dangers in
tho matter of small-pox incident thereto,
and we feel that a word of warning would
not be out of place. Unusual interest in
the issues involved seems to be felt, and
the indications are that the meetings will
be very numerous and very largely at-tended,
and of course by all sorts and con-ditions
of men, as they should be in a
democracy.
In the past six months small-pox has
prevailed in nearly half the counties of
the State. The monthly reports for
March show 437 cases for the month in
28 counties, and "a number of cases" in
another county (for details see Review of
Diseases on a subsequent page). Gener-ally
the disease is very mild in character.
Not infrequently it is so mild that tin-patient
does not feel sick enough to go to
bed, but being a little "under the weath-er"
with what he calls, with the indora -
ment of some complaisant or ignorant
physician, "chicken-pox," he is exactly
in the right condition for visiting around
among the neighbors, or loafing at the
railway station, or above all, attending a
gathering of any kind—political pre-ferred.
In many cases the eruption is so
BULLETIN OP THE NORTH CAROLINA BOARD OP HEALTH.
insignificant as not to attract attention, but
nevertheless it is the genuine article, and
capable of causing in theunvaccinated the
most virulent and fatal form of the disease.
Again, small-pox may be spread by in-fected
clothes. Too often it happens that
the disinfection after recovery is not as
thorough as it ought to be, and the poison
that has attached itself to the clothing
(fomites) remains active. It is hardly
worth while to say that an unvaccinated
man wedged in behind such a coat and
breathing the exhalations from it would
catch small-pox almost to a certainty.
The idea of the possibility of a deliber-ate
and malicious spreading of the disease
by some bitter partisan entered our mind
but was immediately dismissed as absurd.
We read, however, in this very morning's
paper a statement of a case exactly in
point, where a man had had "three buggy
whips worn out on him" because he re-fused
to be vaccinated, and threatened if
possible to catch small-pox and spread it
among his political enemies. But be that
as it may, there is no question of the dan-ger
attached to large gatherings of any
kind in communities where small-pox
—
and especially small-pox of exceptionally
mild type, that is too often falsely called
chicken-pox—is prevalent or has recently
prevailed. Indeed, there is danger now
in all large gatherings anywhere in this
section, for small-pox '
' bobs up serenely '
'
in a most unexpected manner in all sorts
of places. We are fairly well supplied
with points of infection ourselves, but our
sister States continue to re-inforce us in
a most unpleasant and undesirable way,
and one never knows when he may come
in contact with it.
The conclusion of the whole matter is
this : Be Vaccinated. That is the sim-plest,
most certain and practically only
solution of the difficulty.
The Animal Meeting of the Board.
According to the law creating the State
Board of Health the annual meeting
must be held at the same time and place
as that of the State Medical Society. The
latter will assemble at Tarboro on Tues-day,
May 22d, and the Board will meet on
the evening of the same day. The next
day, Wednesday, at 12 St., will occur the
usual conjoint session of the Board with
the Society, when we all take counsel to-gether.
It is extremely desirable that as
many county superintendents and munici-pal
health officers should attend this
meeting as possible. We feel justified in
promising all who come both a pleasant
and profitable time.
The Slaughter of the Innocents.
After a very unusual delay spring has
at last arrived. The vegetable world is
springing into renewed life and growth.
Bacteria belong to the vegetable king-dom
and their growth is promoted by
the same conditions that influence plants
visible to the naked eye. The infection
of milk by certain bacteria and the tox-ines
produced therein by their rapid
development in a temperature above 60°
is the chief cause of cholera infantum
and the infantile diarrhoeas, which are
responsible for such a large per cent, of
the mortality of the summer season. The
fact that ninety-seven per cent, of the
deaths from these causes occur in bottle-fed
babies is significant. A large propor-tion
of these deaths could be prevented
by a little care. Of course the hygiene
of the dairy is important, but this is
beyond the control of the consumer in
most instances. The question therefore
is largely limited to the treatment of the
milk after it has come into her possess-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
ion. It is practically impossible to pre-vent
the infection of the milk, so that the
object to be sought is to destroy, or at
least inhibit, the growth of the bacteria
before they can develop the poison.
This can be accomplished by attention to
three things: pasteurization of the milk
as soon after delivery as possible, keep.
ing it cool after this has been done and
perfect cleanliness of all vessels contain-ing
the milk, the nursing-bottle and nip-ple
in particular.
Pasteurization is a big word, but it is
not a very big thing outside of its bene-ficent
results. There are special appara-tus
for the purpose which can be bought
at a low price, but in the absence of such
it can be practically done in this way:
Get a sufficient number of eight-ounce
bottles from the drug store. After the
first time wash them as clean as possible
and then boil them every morning while
breakfast is cooking. Fill the requisite
number with the milk. Stop their
mouths lightly with raw cotton—germs
cannot pass through raw cotton, it is an
effective strainer for them. Place the
bottles of milk in a tin bucket filled with
water up to their necks, together with a
thermometer. Set the bucket on the stove
and let it remain there until the tempera-ture
reaches 155° or 160°. Then remove
the bucket and wrap it in a blanket or some
other woolen material, leaving it near the
stove in order to keep the temperature as
near that point as possible for a half hour.
At the end of that time take out the bot-tles
and put them in the refrigerator or
the coolest place available. Give the
baby a fresh bottle every time he is fed.
After the cotton stopper is removed the
milk will be re-infected. If possible, all
bottles should be nursing-bottles of such
a character as to permit the fitting on of
the nipple. This would avoid trouble
and the danger from possible carelessness
in thoroughly cleansing the nursing-bottle
if only one is used. The nipple should
be washed clean each time, and kept in
a solution of boracic acid of the strength
of one ounce to a quart of water. The
nursing-bottle should be boiled at least
once every day.
If these directions can be brought to
the attention of mothers so unfortunate as
to be unable to nurse their children, and
they can be induced to conscientiously
carry them out, many a little life will be
saved, and many a mother's heart spared
the keenest anguish.
Leprosy.
The General Government through the
Marine Hospital Service and the Ameri-can
Medical Association through a special
committee are engaged in an investiga-tion
of leprosy in the United States. Ap-peals
for information as to the existence
of the disease in this State have come to
us from both sources. We have replied,
with much satisfaction, that so far as we
were informed there was not a single case
of leprosy in North Carolina. But it may
be that we are not sufficiently informed.
Our sj'stem of health reports outside of
the cities and larger towns is very im-perfect.
It seems to be impossible to get
physicians generally to report at all to their
county superintendents of health. "We
therefore avail ourself of the fact that the
Bulletin is sent to every physician in the
State to ask each one who reads this if he
knows of a case of leprosy to report it to
this office promptly.
A Serious Kiidemie of 1'iieumoiiia in
Carteret County.
( )n the 20th inst. we received a letter
from a physician in the eastern part of the
State saying that a man from Atlantic in
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Carteret county told him that a fatal dis-ease
affecting the "throat" and accom-panied
hy "swelling of the tongue" was
prevailing in his neighborhood, that it
was extremely fatal, and that the people
were almost panic-stricken. He added
that he would call our attention to it and
ask that it be investigated. Dr. Clarke,
the Superintendent of Health of Carteret,
mentioned in his report for February the
occurrence of a very fatal outbreak of
pneumonia in one locality in the county,
but reported nothing special for March.
We immediately wrote Dr. Clarke the
facts as stated to us, and we append his
tragically interesting reply :
Beaupokt, N. C, April 23, 1900.
R. H. Lewis, M. D.,
Rah igh, X. C.
Dear Sir:—Replying to your letter of
April 20th ult., I have to inform you
that the disease of which you inquire is,
or rather was, for no new cases have been
reported since two weeks ago, pneumonia.
I referred in one of my last two reports
to the fact that numerous deaths had oc-curred
in one or two localities along Core
Sound, "presumably from pneumonia."
Since my last report I have made two visits
to Atlantic. Every case seen (five) was un-mistakably
acute lobar pneumonia, and
all young men.
Between twenty and twenty-five deaths
have occurred at Atlantic—all men, so far
as I learned. No children nor women
were affected, and no two cases, so far as
learned, occurred in one house.
Pneumonia (presumably) first appeared
in a locality about twenty miles from At-lantic
earlier in the season, and numerous
deaths occurred. Several intervening com-munties
have been unaffected (uninfected).
Atlantic is a thickly settled community
of several hundred people, really a town.
The fact that practically men only have
suffered is accounted for by the fact that
after infection they have been exposed
to the weather, frequently wet by rain or
salt water (they all live by fishing, crab-bing
or catching oysters).
The women and children are even
more exposed to the primary infection,
being more closely confined to the house,
but lack the secondary or inciting cause,
and in their cases pneumonia has not
been developed.
I may say that at a first visit I invari-ably
found a house packed with people,
so that infection was general after one or
two cases had occurred. I of course gave
them different instructions, both on their
own and the patients' account, and advised
them to avoid exposure and getting
chilled until mild weather appeared.
No new cases have occurred since my
last visit. I saw some men from Atlan-tic
this morning who left home yesterday
(Sunday) and questioned them.
Yours truly,
F. M. Clarke.
Small-pox in Mississippi.
The small-pox has existed in mild form
in Mississippi for three years. In Febru-ary
in Hinds county it suddenly assumed
a virulent and loathsome form, and dur-ing
the past six weeks there has been
over 100 deaths. On some days the death
rate has been so large that it was impos-sible
to secure coffins. Whole families
have been wiped out of existence, and of
several large families only one or two
children are left. The absence of deaths
in the beginning, the disagreement con-cerning
diagnosis among the physicians,
the apathy of the business men and the
general failure to support preventive
measures, all contributed their part to
this finale. It is good business to put
out even little fires, and it is equally good
business to put out even little epidemics. —Bulletin of Indiana Board of Health.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Review of Diseases for March, 1900.
EIGHTY-FIVE COUNTIES REPORTING.
Ninety-three counties have Superinten-dents
of Health.
Except in the case of the more contagious
and dangerous diseases, the Superintendent
has, as a rule, to rely upon his own infor-mation
alone, since few physicians can be
induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise in-dicated,
its mere presence in the county is
to be understood as reported.
For the month of March the following
diseases have been reported from the
counties named
Measles.—Alamance, 200 ; Alleghany,
general; Ashe, 60; Beaufort, several; Ber-tie,
several ; Caswell, several ; Chatham,
many ; Cherokee, many ; Clay, 2 ; Cleve-land,
a few ; Columbus ; Craven, 20
;
Duplin, many ; Graham, several ; Gran-ville;
Greene, 300; Guilford; Halifax,
general; Harnett, 50 to 100 ; Hertford, 4;
Iredell, 5 ; Johnston, general ; Jones,
several ; Martin, 50 ; Montgomery, 6
Moore, 5; Nash, epidemic; New Hanover,
8; Orange; Pasquotank, 2; Person, 7; Pitt,
general ; Rutherford, a few ; Sampson, a
few; Swain, 1 ; Vance, several; Wake, 6,
many others in one section; Watauga,
general ; Wayne, 30 ; Wilkes, in many
parts; Wilson, general; Yadkin, 4—42
counties.
Whooping-cough.—Beaufort, several
;
Caldwell, 10 ; Cleveland, many ; Colum-bus
; Craven, 8 ; Currituck, 2 ; Duplin, a
few; Durham, a few; Graham, several;
Granville; Greene, 200; Halifax, general;
Harnett, a few; Henderson, many; Ire-dell,
4; Johnston, general; Macon, several;
Martin, 50 ; Mecklenburg ; Montgomery,
10; Nash, epidemic; Orange; Pitt, general;
Richmond, general ; Robeson ; Stanly,
several; Swain, 2; Transylvania, 10; Wake,
3; Watauga, general—30 counties.
Scarlet Fever.—New Hanover, 1; Pas-quotank,
1; Vance, 1.
Diphtheria.—Mecklenburg, 1 ; Mont-gomery,
2; New Hanover, 1; Wake, 1.
Typhoid Fever.—Alamance, 3 ; Ashe,
6; Beaufort, a few; Cabarrus, 4; Chatham,
a few ; Columbus, 1 ; Dare, 2 ; Harnett, a
few ; Hertford, 1 ; Madison, 2 ; Mecklen-burg
; Montgomery, 4 ; New Hanover, 2 ;
Robeson; Stanly, several; Union, 4; Vance,
1; Wake, 2; Warren—19 counties.
Malarial Fever.—Beaufort ; Craven ;
Hyde ; Johnston ; Person ; Wake.
Malarial Fever, Hemorrhagic —
Craven, 1 ; Hyde, 2 ; Person, 1 ; Wake, 1.
Influenza.—Alleghany, Beaufort, Ber-tie,
Caldwell, Carteret, Caswell, Catawba,
Chowan, general ; Cleveland ; Craven ;
Currituck ; Duplin ; Forsyth, Graham,
Guilford, Halifax, general; Hertford;
Iredell, general ; Johnston ; McDowell
;
Macon, Martin, Mitchell, Moore, New
Hanover, general; Northampton; Onslow,
Pender, general; Person; Richmond, gen-eral;
Robeson; Sampson, in many parts;
Stokes, general ; Surry ; Swain ; Union ;
Wake ; Washington, Wilkes, general
—
39 counties.
Pneumonia. —Alleghany ; Buncombe ;
Carteret; Catawba; Chowan, in all parts;
Dare, 2 ; Forsyth, in all parts ; Franklin ;
Gaston, common ; Gates, in grave form,
with many deaths; Granville, in all parts;
Hyde ; Martin, more than ever before
;
Northampton, in some parts; Onslow;
Pasquotank ; Person ; Sampson, in many
parts ; Swain ; Union ; Wake ; Washing-ton,
in all parts; Yadkin—23 counties.
Mumps.—Caswell, in nearly all parts ;
Cumberland, in all parts; Halifax, in all
parts; Pitt, in all parts; Washington, 1 ;
Watauga, in all parts—') counties.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Eoseola.—Caswell, Gaston, general.
Vaeicella. — Cumberland, Halifax,
general.
Small-pox.—Alamance, 20; Alexander,
3; Buncombe, 15, under control; Burke,
1; Cabarrus, 1; Caswell, 1; Chowan, 6;
Davidson, 3; Davie, 8, one death; Dur-ham,
3 ; Gates, 2 ; Guilford, 61 ; Harnett,
5; Henderson, 1, stamped out ; Hertford,
3; Iredell, 1 ; Johnston, 1 ; Mecklenburg,
18, in the western part chiefly ; Moore,
67 ; Nash, 10 ; New Hanover, 2 ; Orange,
20; Person, 17; Randolph, 1, confluent;
Robeson, 27; Rockingham, 120, six
deaths; Rutherford, a number of mild
cases; Stanly, 1, following 20 in February
no spread after quarantine and vaccina-tion;
Warren, 1—29 counties.
Cholera in Fowls.—Hyde.
Cholera in Hogs.—Bladen; Columbus,
less than in former years ; Hyde ; Moore.
Hydrophobia in Dogs.—Ashe; Caswell.
Pink Eye in Horses.—Cherokee.
No diseases are reported from Bladen,
Edgecombe, Haywood and Polk.
No reports received from Anson, Bruns-wick,
Jackson, Lenoir, Lincoln, Per-quimans,
Rowan and Yancey.
Summary of Mortuary Reports for
March, 1900.
(twenty towns).
Only those towns from wThich certified
reports are received are included.
White. Col'd. Total.
Aggregate popula-tion
68,875 50,075 118,950
Aggregate deaths... 91 74 165
Representing tem-porary
annual
death rate per
1,000 15.9 17.7 16.6
Causes of Death
Typhoid fever 12 3
Malarial fever 112 Measles.: 11 Pneumonia 24 14 38
Consumption 12 10 22
Brain diseases 5 16 Heart diseases 6 6 12
All other diseases.. 40 37 77
Accident 2 2 4
91 74 165
Deaths under five
years 17 17 34
Still-born - 4 8 12
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for March, 1900.
Towns
and reporters.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. E. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. D. B. McNeill.
Buncombe Dr. E. E. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. F. Houck.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham ...Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Floskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J.Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bvnum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. H. Cannady.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. W. L. Crouse.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. George F. Lucas.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. W. C. Bostic.
Randolph Dr. T. T. Ferree.
Richmond Dr.v
J. M. Covington.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford '..Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland
Stanly Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. P. E. Hines.
Warren Dr. T. B. Williams.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. W. J. Jones.
Wilkes Dr J. W. White.
Wilson Dr. W. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancev Dr. W. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 9
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each mouth, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
.189-— N. C.
B"criL.i-.E]Ti3^r
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Riehlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. MAY, 1900. No. 2.
Drinking Water.
It is with genuine satisfaction that we
lay before our readers the truly excellent
paper on the above subject, read at our
last Health Conference by Dr. Pate. It
is directly to the point and presents the
subject of drinking water in its relation
to disease in a clear, forcible and practi-cal
manner. The same thing has been
done time and again by writers on sani-tation,
but we do not remember to have
ever seen it better done in the same space,
if at all.
We desire to commend especially to
the thoughtful and conscientious consid-eration
of our medical readers what Dr.
Pate says in regard to the responsibility
of the family physician in this connec-tion.
As we have repeatedly said in
these columns, no board of health, no
matter how complete in organization,
equipment and endowment, can do thor-ough
work without the action and hearty
co-operation of the medical profession.
The disastrous consequences of the indif-ference
or opposition of an occasional in-dividual
member of the profession is at-tested
by more than one widespread
epidemic of smallpox in our State in the
recent past. The family physician should
be the sanitary as well as medical adviser
of those who intrust themselves to his
care. No one can be such an effective
health officer as he directly, as he is
the maker of public opinion on medical
and sanitary lines, and the failure of the
best directed efforts to protect the health
of the people is too often due to his indif-ference
and failure to say a few words in
season. This very thing has discouraged
us more than all else, but there has been,
we are gratified to sa"y, a marked im-provement
of late in this respect. May
it increase:
DRINKING WATER.
Read at the Wilson Health Conference.
BY DR. W. T. PATE, OF GIBSON, N. C.
It has been my observation that there
is no surer way to displease ;> friend, or
block the avenues to friendly relations
with a stranger, than to condemn his
drinking water. Associations have in-vested
our water supplies with a aenti
12 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
ment next to home itself. It seems hard
to realize that the spigots that have ad-ministered
to our wants and necessities
in days of health and pleasure could in
an evil hour dispense sickness and be-reavement;
or that the well that had fur-nished
water to raise a family could also
exterminate it. It is not my purpose to
rob this necessary element to our exist-ence
of any of its sentiment, but to try to
make it more deserving by calling atten-tion
to the fact that the good and bad are
so thoroughly mixed in all things that it
even applies to water supplies.
All drinking water, unless it be that
from deep artesian wells, contains bacte-ria,
or unicellular vegetable organisms,
which are like vegetables of a higher
type, in that some kinds are harmless
—
even wholesome,—while other kinds are
poisonous. We speak of water as being
contaminated when it contains some of
these poisonous organisms. The chief
source of the bacteria found in drinking
water is from the soil. For our purpose
we will speak of the modes of contamina-tion
as direct and indirect. Direct when
the dangerous bacteria are introduced
into the water from first hands. Indirect
when the bacteria are deposited upon the
earth and then carried into the drinking
water by the rain that falls upon the sur-face
or the water that percolates through
the soil.
About 7 per cent, of the population of
North Carolina obtain their drinking
water from public supplies, the source of
nearly all of which is surface-water ex-posed
to both direct and indirect contam-ination.
But these supplies are better
than private wells in city soil. They are
easier to protect, and are capable of such
intelligent management as will place them
within the bounds of safety. But this
will hardly be accomplished before an
educated public sentiment demands it.
When the consumers of public water
fully realize that pure water and a good
health record go hand in hand to attract
desirable home-seekers and capital; when
they thoroughly appreciate the fact that
their own prosperity, happiness, health
and lives may depend upon the purity of
their drinking water; when they feel
that the suffering and death from typhoid
fever in the community are due to
some one's carelessness and might be pre-vented—
then they may be depended
upon to see that every precaution known
to sanitary science is thrown about the
public water supply.
The men occupying the best position
to teach these truths of sanitation and
create this public sentiment are the phy-sicians
of the town. Any town having a
public water supply that is causing an
unusual number of cases of typhoid fever
and other water-borne diseases is a re-proach
to the physicians of the commun-ity.
Every man of means and influence
has a family physician, and if that guar-dian
of the health of the home will take
the pains to impress upon his patron the
importance of pure drinking water, he
will not only demand it, but will support
any reasonable measure to improve and
protect the public supply. I say this
with all due respect to our efficient State
Board of Health. Its work is gaining in
appreciation among the people, and is
attracting attention beyond our own bor-ders.
I have heard its work commended
from the State of Maine. But the Board
can at best only direct, map out the
work and suggest plans. If the highest
practical good is to be accomplished for
the community and the State, the Board
must have the hearty, active co-operation
of her intelligent citizens, and especially
that of the medical profession.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 13
The remaining 93 per cent, of our pop-ulation
represent the inhabitants of the
smaller towns and the country, who are
less fortunate than their city cousins, in
that each home has its own supply, and
must bear the expense and exercise the
necessary care to keep their drinking
water in a safe condition or suffer the
consequences. The chief burden of these
supplies is sustained in complying with
the last named condition. These sup-plies
consist principally of dug or open
wells and driven wells. The latter are
safer, since they are exposed only to
indirect contamination. Open wells from
which the water is brought to the sur-face
in buckets, are filthy and dan-gerous.
Any one who has seen one of
these wells cleaned out knows what
a quantity of filth finds its way into
the water from the open top. Every one
that draws a bucket of water handles the
wet bucket and chain and sends it down
to be washed off by the water in the
well, which amounts to about the same
thing as washing the hands in the drink-ing
water, not to speak of contamination
by mosquitoes and other insects. Such
wells undoubtedly cause many cases of
gastro-intestinal troubles, not usually fa-tal,
except among small children. And, if
typhoid fever is carried to a home using
an open well, it takes intelligent manage-ment
to prevent the drinking water from
becoming contaminated, and servants do
not always possess the necessary intelli-gence,
as was shown in a case that came
under my observation at a farm-house
two miles east of Gibson.
This well had been in use more than
five years. It was the boast of the owner
that he had the best water in his section,
and that there had never been a case of
typhoid fever on his plantation. During
the winter of 1895 a son was carried to
this home with a well developed case of
typhoid fever. A nurse was employed at
once, the patient isolated, and the physi-cians
in attendance thought every pre-caution
had been taken to protect the
other members of the household; but in
about three weeks two other members of
the family were sick with the fever. The
physicians were puzzled until it was
learned that the launderer had remarked
that the ' doctors might know something
about medicine, but that they didn't
know anything about washing; and in-stead
of carrying the linen, bundled by
the nurse, from the sick-room to the ket-tle
and boiling for a half hour before
washing, as directed by the physicians,
he had first washed the clothing in warm
suds, drawing his own rinsing water at
the open well. This act of carelessness
and ignorance cost the life of one mem-ber
of the family.
Another case showing the extreme lia-bility
of open wells to typhoid contami-nation
occurred just across the line from
Gibson in South Carolina. Another
plantation home—an open well with
sweep, hand-pole and bucket—a bench
adorned by a row of tubs—a wash-pot,
and a mud-hole with a few brickbats in
it—all within a radius of 15 feet—the
counterpart of many domestic water sup-plies
in North Carolina to-day.
There had been no case of typhoid
fever here. During the winter of 1884 a
married daughter died of typhoid fever
in another county. Her sick child was
carried by its grandmother to this home,
some 15 miles away. The child died;
members of the household and neighbors
and friends who visited them in due time
began to have fever; an epidemic broke
out in the community; and if it were
possible for any one to state the number
of cases that were carried directlv and in-
14 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
directly from that well, the cost of life
and property to the community, it would
seem incredible. I know that some fami-lies
were so reduced by sickness, death
and debt that their homes went into
other hands.
Where it is practicable only driven
wells should be used to obtain water for
domestic purposes. Where it is necessary
to dig wells, after an unfailing flow of
water is secured, terra-cotta well-pipe
should be placed in the well and the well
filled in, the top closed and the water
raised by suction. Where the terra cotta
pipe is too costly a two inch iron pipe can
be carried to the bottom of the well, this
filled around with stones above the level
of the water, three feet of chalk and clay
packed in above the stones and the well
filled with clean earth. This will prevent
direct contamination, and lessen the at-traction
for surface-water. Indirect con-tamination
can be prevented by a clean
soil. A circle with a radius of 100 feet
should be drawn around the well and the
perimeter designated the danger line, and
nothing that would pollute the soil should
be allowed within this circle—not even
an open well. I have seen driven wells
placed within a few feet of an open well
to improve the water supply. It is need-less
to say that there was no improve-ment.
All waste-water from the well,
wash-basins, etc., should be conveyed be-yond
the clanger line in water-tight pipes.
Another important matter is surface
drainage. The stables, pig-styes, etc.,
should be so placed on the premises that
the surface—drainage will be away from
the well. One hundred feet, nor any
other reasonable distance, will not pro-tect
a well on a slope below polluted soil.
I have seen a driven well 28 feet deep on a
slope 300 feet away from a basin polluted
for a generation, contain intestinal bacilli
from the first. Another instance is that
of a factory village built on an eastern
slope. Near the brow of the hill is a row
of out-houses. One hundred feet or more
down the grade is a broad street, a row
of houses on either side of the street, and
driven wells along its centre, more than
100 feet from the out-houses, along the
brow of the hill. For the first few years
the village was not infected with typhoid
fever. In December, 1895, I was asked
by the president of the company to see a
boy in the village that was thought to be
crazy. I found him sitting up, tempera-ture
104, delirious, with other symptoms
of typhoid fever. The attention of the
president of the company was called to
the bad arrangement of the village, and
warned of the danger. A meeting of the
directors was called, but nothing was
done. The number of cases have in-creased
year by year until now. In Sep-tember
I was informed by one of the
three physicians who practice among the
operatives that he then had thirty cases
of typhoid fever under treatment in the
village, and that the death rate was high.
This is due to the surface-water from the
row of out-houses along the brow of the
hill running down the slope and infect-ing
the wells.
In conclusion, I would say: Use only
underground wells; raise the water by
suction; see that the soil is free from pol-lution
within 100 feet radius of the well,
and drain all polluted soil on the prem-ises
away from the well. By a strict ob-servance
of these simple precautions it is
possible, in a primitive soil, to obtain
water with less than 100 harmless bac-teria
per cubic centimeter.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 15
••Death in the Pot."
Such was the title of a treatise pub-lished
in England in 1820, calling atten-tion
to the adulteration of food and its
often injurious effects upon the system.
Owing to chemical discoveries the facili-ties
for adulterating food within the past
few years have been much greater than
ever before, from the fact that almost
every variety of food is now put up in
enormous quantities in cans, and spices
of every kind pulverized and sold to the
public in small packages, so that their
purity can only be detected by careful
analysis. Some of these adulterations
are comparatively harmless, simply de-creasing
the strength and value of the
product, but others, which are more
commonly used in the finer quality of
goods, disguise their real condition, and
by their drug action disturb the digestion
and poison the blood.
An article in the Lancet, of April 22,
speaks of meat extracts of "vile origin,"
showing they are sometimes made of
putrid liver and offal, and that such
filthy material is fabricated into a tooth-some
paste, the use of deodorizers and
subtle flavoring material having been
placed at the disposal of offal-mongers by
the advance of chemical knowledge. Of
course cooking would destroy most nox-ious
germs, but their products, the pois-onous
ptomains, would remain and their
presence in an extract would cause very
serious symptoms of poisoning. The pro-ceedings
of the War Investigating Com-mittee
called the nation's attention to the
action of adulterated food, and if it was
productive of no other benefit, it led to
official reports in several States of the
alarming extent to which the adultera-tion
had been carried with well-localized
f poisonous results.
Mr. "Wells, the Pennsylvania Food and
Dairy Commissioner, states that chemi-cal
companies have agents traveling ail
over the State selling to butchers chemi-cals
for preserving meat. The packages
are labeled, telling how they are to be
used. And some of them are used wher.
the putrefaction has already commenced.
In the last annual report of the Connec-ticut
Experimental Station it is stated
that of sixty-three samples of jellies, two-thirds
were adulterated, not only with
starch and glucose, but with aniline dye
and salicylic acid. Out of forty samples
of marmalades and jams only three were
pure. Of forty-seven samples of beer
and ale, twelve contained salicylic acid,
and nineteen samples of sausages and
oysters were found embalmed by boric
acid. Salicylic acid as a food preserva-tive
has been forbidden by several Euro-pean
governments. Here it is largely
used by canners and butchers. The De-partment
of Agriculture found it in fif-teen
out of twenty samples of string
beans, in ten out of twelve samples of
baked beans, and in twenty out of forty-one
cases of corn. Is it any wonder, in
face of this adulteration of so many of
the common articles of daily food, that
so much dyspepsia and general derange-ment
of the system, produced by it, ex-ists
to so large an extent in our populous
towns and cities? Salicylic acid, the
favorite preservative used, has been pro-nounced
by the Paris Academy of Medi-cine
not only provocative of, but espe-cially
injurious to, dyspeptics. The bodily
sufferings of hosts of individuals, for
which no adequate cause is assigned, are
undoubtedly due in many, very many,
cases, to the systematic food poisonii g
for the profit of dishonest dealers. The
coal-tar products are used to a large ex-tent
in cheap confectionery and in the
16 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
flavoring extracts of the kitchen. In a
Western hotel nearly all the guests be-came
sick, and the cause was traced to
the cheap coal-tar extracts used in the
kitchen. To remedy this wholesale pois-oning
from adulterated food it has been
suggested that a national food commis-sion
be organized with the power of ex-amining
manufactured products and
testifying as to their quality, these pro-ducts
of food and drink to have on printed
labels the contents of the packages.
Every physician, if properly trained in
laboratoiy work, would be entirely com-petent
to determine the condition of
every product of food or drink, as it re-gards
adulteration, submitted to him.
But to accomplish this, more efficient in-struction
should be given in chemical
analysis in our medical colleges, and
questions introduced into the State medi-cal
examinations fully testing the knowl-edge
of students in the action of drugs
used in all adulterations connected with
food and drink, and their ability to de-tect
these poisons by the necessary un-failing
scientific tests. The examination
by the State Board of Examiners in this
department of medical studies should be
so minute and so exhaustive as to leave
no doubt that the student was thoroughly
competent for all the details of the work
as it regards examination, and the medi-cinal
action of the materials used upon
the human system. We respectfully call
attention of the Regents to the impor-tance
of this suggession.—A'. Y. Medical
Tiim 8.
Review of Diseases for April, 1!)00.
EIGHTY-FOUR COUNTIES REPORTING.
Ninety-three counties have Superinten-dents
of Health.
Except in the case of the more contagious
and dangerous diseases, the Superintendent
has, as a rule, to rely upon his own iufor-mation
alone, since few physicians can be
induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise in-dicated,
its mere presence in the county is
to be understood as reported.
For the month of April the following
diseases have been reported from the
counties named
:
Measles.—Ashe, 40; Bertie, many;
Buncombe, 50; Carteret; Caswell, several;
Chatham, many; Cherokee, many; Cleve-land,
a few; Columbus; Craven, S; Cum-berland,
in all parts; Davidson; Graham,
25; Granville; Greene, 800; Halifax, in
many parts; Harnett, 300; Hertford, 2;
Martin, 200; Nash, epidemic; New Han-over,
55; Northampton; Pasquotank, 2;
Perquimans, ti; Person; Pitt in all parts;
Richmond, general; Robeson, epidemic;
Rockingham; Rutherford, many; Samp-son,
a few; Surry, 6; Wake, 8; Warren,
some: Washington, 20; Watauga, general;
Wayne, 25; Wilkes, 1; Yadkin, in all
parts— 39 ceunties.
Whooping-cough. —Beaufort, several;
Bertie, many; Buncombes many; Bladen,
a few; Caldwell, 10: Cleveland, a few; Col-umbus,
general; Craven, 6; Gates, many;
Graham, 20; Greene, 500; Halifax, in
many parts; Iredell, many; Macon; Madi"
son, 40; Martin, 50; Mecklenburg; Nash;
New Hanover, '.»; Person; Stanly, several;
Warren, a few; Watauga, general — 23
counties.
Scarlet Fever. — Mecklenburg, 3;
Rockingham, 1; Vance, 1.
Diphtheria.—Craven, 2; Mecklenburg,
1; Surry, 1.
Typhoid Fever.—Alamance, 3; Ashe,
2; Cabarrus, <>; Chatham, a few; Colum-bus,
2; Craven, 2; Durham, 1; Greene, 1;
* Haywood, 3; Nash, 2; Perquimans, 2;
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17
Rockingham; Stanly, 4; Union, 3; Vance,
1 ; Warren, a few—16 counties.
Malarial Fever.—Hyde.
Malarial Fever, Hemorrhagic.—
Hyde, 1.
Malarial Fever, Pernicious—Hyde, 2.
Influenza.—Alamance; Ashe, general;
Bertie, in many parts; Buncombe; Cald-well,
in most parts; Carteret; Catawba,
general; Chatham, general; Chowan, gen-eral;
Clay, influenza; Columbus; Curri-tuck;
Davidson; Franklin; Gaston; Gates,
general; Graham, general; Greene, gen-eral;
Harnett, general; Henderson, gen-eral;
Hertford; Hyde, general; Iredell,
general; Lenoir, general; Lincoln, gen-eral;
McDowell; Macon, general; Martin,
general; New Hanover, general; North-ampton;
Orange, general; Pender, in
many; Perquimans, 5; Person; Pitt, gen-eral;
Randolph, much; Richmond, gen-eral;
Robeson; Rutherford; Sampson;
Stanly, general; Swain; Transylvania;
Union; Vance, general; Wake, general;
Watauga; Wayne; Wilkes; Yancey, gen-eral—
51 counties.
Pneumonia. — Ashe, general; Bun-combe,
Carteret: Catawba, general; Cher-okee;
Gaston; Gates, general; Harnett,
general; Jackson; Pender; Pitt, general;
Rutherford; Sampson, general; Wake,
general; Wilkes; Wilson, general; Yad-kin,
general—17 counties.
Mumps.—Beaufort, general; Carteret;
Caswell, in all parts; Davidson; Halifax;
DcDowell; Northampton; Person; Wash-ington,
in all parts—9 counties.
Roseola. —Bladen; Caswell, in all
parts; Union.
Rubella. —Craven, epidemic.
Rotheln.—Mecklenburg; Sampson, in
all parts.
Varicella.—Cumberland, in all parts;
Halifax; Richmond, in all part-.
Small-pox.—Alamance, 18; Alexander,
12; Buncombe, 21; Cabarrus, 4; Caswell,
14; Chatham, 11; Cleveland, 11; Cumber-land,
1; Davidson, 6; Davie, 14; Durham,
]•'.; Forsyth, 1; Gaston, 3; Granville, 1;
Guilford, 32; Harnett, 8; Haywood, 1;
Hertford, 6; Johnston, 32, for February
the number should have been given as
4; Mecklenburg, 18; Nash, 25; Orange, 17;
Pender, 8; Person, 11; Randolph, 6; Robe-son,
6; Rockingham, 291; Stanly, 2;
Wake, 9; Wilkes, 1—30 counties.
Cholera ix Hogs—Columbus, to some
extent.
Distemper in Horses. —Richmond,
Wake.
Hydrophobia in Dogs.—Ashe.
No diseases are reported from Dare,
Edgecombe, Mitchell, Polk and Stokes.
No reports received from Alleghany,
Anson, Brunswick, Cherokee, Duplin,
Jones, Montgomery, Moore and Rowan.
Summary of Mortuary Reports for
April, 1900.
( N I N ETEEN TOWNS)
.
( >nly those towns from which certified
reports are received are included.
White. CoVd. Total.
Aggregate popula-lion
....!. 67,375 49,575 116,950
Aggregate deaths... 92 97 189
Representing tem-porary
annual
death rate per
1,000 16.3 22.S L9.2
Causes of Death.
Typhoid fever 1 °
Scarlet fever
Whooping cough... 1
Pneumonia 15 1 ( >
->l
Consumption 8 ''
Brain diseases 3 •_>
Heart diseases 6 >_
Diarrhceal diseases 4 3 <
All other diseases.. 49 63 H-Accident
4 5
92 97 189
Deaths under five
vears 13 30 43
Still-born - 4 L5 19
18 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for April, 1900.
Towns
and Reporters.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 19
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr.-B. E. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. D. B. McNeill.
Buncombe Dr. E. R. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. F. Houck.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins. <
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J.Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks. .
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum,
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. H. Cannady.
Greene Dr. Joseph E. Grimsley
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. W. L. Crouse.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. George F. Lucas.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. W. C. Bostic.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Covington.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford .'Dr. W. A. Thompson.
Sampson •. Dr. R. E. Lee.
Scotland
Stanly Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. P. E. Hines.
Warren Dr. T. B. Williams.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. W. J. Jones.
Wilkes Dr J. W. White.
Wilson Dr. \Y. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancey Dr. W. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. '21
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever -
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever .-- Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190— V 0.
BTTLiILiIETXlfl"
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. JUNE, 1900. No.
Annual Meeting of the Board of
Health.
The annual meeting of the Board was
held at Tarboro May 22—23, all the mem-bers
being present.
Among other things, resolutions were
adopted requesting the State Board of
Agriculture to slightly amplify their pro-posed
biological laboratory so as to pro-vide
for the bacteriological examination
of drinking waters, when requested by
the Secretary of the Board of Health.
These resolutions were duly presented to
the Board of Agriculture at its recent
meeting, and we are glad to say were re-ceived
with favor, unanimous action be-ing
promptly taken with a view to carry-ing
out our request. Much good will
doubtless be accomplished by this en-lightened
action of the Board of Agricul-ture,
and, for the people of the State, as
well as the Board of Health, we wish to
express our appreciation of if.
The conjoint session with the State
Medical Society was called to order at 12
m. of Wednesday, the 23d, the second
day of the meeting of the Society, accord-ing
to the custom of many years, Dr.
Charles J. O'Hagan presiding, in the
necessary absence of President Thomas
at that time. Dr. O'Hagan on taking the
chair, with the readiness and grace as a
speaker so characteristic of him, deliver-ed
a very interesting address on general
lines, literally on the spur of the moment,
as he was entirely without notice.
The annual report of the Secretary, and
the two small-pox inspectors, Drs. Harrill
and Tayloe, were read.
On motion, the Secretary was thanked
for his labors-, and a copy of his report
ordered printed and distributed to the
physicians and the county commissioners
of the State.
Resolutions in regard to pure food
legislation, the outside insane, and small-pox
were adopted.
The reports and the resolutions were
as follows
ANNUAL REPORT OF THE SECRE-TARY
OF THE NORTH CAROLINA
BOARD OF HEALTH.
The work of the Board, since my last
report, in addition to the regular routine
of the Secretary's office, made up chiefly
24 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
of advice on sanitary subjects to individ-uals,
municipalities, corporations, and
health officers in person, by letter, and by
telegram, and the preparation of matter
for the monthly Bulletin, has consisted
in inspections of some of the State insti-tutions,
the. holding of the annual health
conference with the people, and the
effort to direct, as far as our powers per-mitted,
the management of the epidemic
of small-pox, which I regret to say has
prevailed quite extensively throughout
the State during the past year.
[NSPECTIONS OF STATE INSTITUTIONS.
Inspections by committees from the
Board, appointed by the President, have
been made of the three Hospitals for the
Insane, the University, the Normal and
Industrial College, the two Agricultural
and Mechanical Colleges, the school for
the Deaf and Dumb at Morganton, and,
at the special request of his Excellency,
the Governor, of the abandoned convict
camp at Castle Hayne, with a view to its
healthfulness for that purpose. With the
exception of the State Normal and Indus-trial
College at Greensboro, we found all
the institutions in a good sanitary condi-tion,
although a more abundant water
supply is needed at the University.
Learning that the Board of Trustees of
the Normal and Industrial College would
meet before the report of the regular
Committee of Inspection could reach
them, I felt it my duty to make a per-sonal
visit to that institution and supple-ment
the investigation already made, so
that I might be in a position to advise
directly with the Board. I was invited
to appear before the Board and make to
them a verbal report of my investigations,
and to give them my views as to the sit-uation.
Having done this, I was re-quested
to prepare a full and candid re-port,
suppressing nothing, and give it to
the leading newspapers of the State.
This was promptly done, and sent to all
the morning dailies in the State. It was
also printed in the Bulletin, and as every
physician whose address is known re-ceives
regularly a copy of that publica-tion,
you have already read it, or have
had an opportunity to do so, at any rate,
and it would, therefore, be superfluous to
repeat it here. After this report was
given to the newspapers, I made two
other visits to the Normal and Industrial
College, and learned certain additional
facts which confirmed the view first ex-pressed,
that the cause of the outbreak
of typhoid fever was the water of the
central well which was drunk by all the
students taking their meals in the Col-lege,
to whom the sickness was limited,
and which was found by two bacteriolo-gists,
Drs. Albert Anderson, of Wilson,
and A. C. Abbott, of Philadelphia, to be
infected with intestinal bacilli. These
new facts were set forth in a supplemen-tary
report, which was printed, together
with the original report, in the Bulletin
for December, 1899. The medical report
of the fever by Dr. W. P. Beall, of Greens-boro,
the chief consultant, was given to
the profession through the columns of
the Carolina Medical Journal, and was
reprinted in the Bulletin for February.
In round numbers, one-third of the total
college population had fever, and there
were fourteen deaths. As every county
in the State had a representative in the
student body, and most of them one
among the sick, the deep solicitude and
wide- spread interest felt throughout the
State, not only in that particular out-break,
but iu the subject of typhoid fever
in general, its causation and its prevention,
can be easily understood. Realizing this,
I availed myself of the opportunity to
"point a moral" at the conclusion of the
report referred to in the following words:
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 25
"Every city and town should have an
expert inspector of plumbing, and require
inspection by hitn of every job before it
is covered up and accepted, and all public
institutions and private boarding schools
and other establishments with plumbing
should require a similar inspection. AVells
near sewers, or any accumulation of filth,
especially of human origin, are danger-ous.
Guard with jealous care the purity
of your drinking water."
Whether any of our cities and towns
have acted upon the suggestion as to the
employment of an expert inspector of
plumbing, and the requirement that all
plumbing work should be inspected and
approved by him before being accepted,
I have not been informed, but the sug-gestion
as to drinking water did bear
some fruit. The University and the Ag-ricultural
and Mechanical College for
whiten, of the State schools, and St.
Mary's, at Raleigh, and the Horner Mili-tary
School at Oxford, of the private ed-ucational
institutions, had bacteriological
examinations made of their water sup-plies,
thereby exhibiting a progressive
and enlightened spirit that is worthy of
commendation, and setting an example
that it would be wise for others to follow.
While the outbreak of typhoid fever at
the Normal and Industrial College is
greatly to .be deplored, its educational
effect upon the people has been great, and
the final result in the coming years will
no doubt be the saving of many more
lives than were lost. The history of san-itary
science shows that no material ad-vance
in its practical application has ever
been made, except as a consequence of
some tragedy of this sort.
THE HEALTH CONFERENCE.
In the hope of interesting and instruct-ing
the people of some of our largest cities
and towns in matters pertaining to the
public health, meetings of the Board with
the people for the purpose of discussing
before and with them, in a practical and
popular way, sanitary subjects, were in-augurated
at Salisbury in 1893. Since
that time similar meetings have been held
in order at Washington, Charlotte, Golds-boro,
Winston-Salem, and Wilson. We
have been assured that they were helpful
in promoting the cause they were de-signed
to serve, but it must be confessed
that appreciation by the people of these
efforts on the part of the Board has not
increased, the first two having been the
most successful. It is true that rival at-tractions
of a more entertaining character
have interfered on three occasions, and
they may have been the explanation of
the comparatively small attendance, al-though
it has invariably been excellent
in quality and respectable in numbers.
It certainly cannot be attributed to a
falling off in the quality of the work done
by the members of the Board participa-ting,
as the papers and addresses were
never better, if so good, as those present-ed
at the last conference at Wilson, the
announcement and programme of which
was as follows
HEALTH CONFERENCE AT WILSON
.NOVEMBER 1, 1899.
AIMS AND OBJECTS.
The Conference is intended to be be-tween
the members of the State Board of
Health and the people. Its object is to
interest the people in sanitary matters by
explaining and impressing upon them the
great importance to the individual and to
the community of a strict observance of
the laws of health. Its proceedings will,
therefore, be not technical but popular in
character, and every one present will be
invited to participate therein, by taking
part in the discussions and by asking
26 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
questions, which the members of the
Board will take pleasure in answering to
the best of their ability.
As the enforcement of sanitary rules in
the family is largely in the hands of the
mistress of the household, the ladies are
especially invited to attend.
Papers or addresses are promised on
the following subjects:
Old Age and How to Attain it.—By Dr.
J. L. Nicholson, Richlands, member of
the Board.
Vaccination as an Economic Measure.—
By Dr. Henry H. Dodson, Milton, mem-ber
of the Board.
Malaria and Mosquitoes.—By Dr. Rich-ard
H. Lewis, Raleigh, Secretary of the
Board.
A Discussion of the Health Lairs now
Operative and, Reasons why they should be
Earnestly Supported by the Public.—By Dr.
George G. Thomas, Wilmington, Presi-dent
of the Board.
The North. Carolina Health Law and the
Local Health Officer.—By Dr. Henry W.
Lewis, Jackson, member of the Board.
Practical Hints on Drinking Water.���By
Dr. W. T. Pate, Gibson, one of the Bac-teriologists
to the Board.
There will be a Question Bos, and per-sons
in the audience too modest to speak
out in meeting can write them out and
deposit them in the same for answer by
some member of the Board. Opportunity
will be given for this at the end of the
discussion of each set subject.
The meetings will be held in the court-house
at 10 a. m. and 7:30 p. m.
You are cordially invited to attend and
bring your friends.
Richard H. Lewis, M. D.,
Secretary.
N. B.—The subjects will not necessarily
come up in the order in which they ap-pear
above.
In view, however, of the sacrifice in
time and labor required of the members
of the Board, and the expense incident
to the meetings, it is a question as to
whether they should not be discontinued.
An expression of opinion by members of
the profession outside of the Board would
be welcomed.
COUNTY SUPERINTENDENTS OP HEALTH.
In planning the construction of our
health laws, the County Superintendent
of Health was made what might be called
the corner-stone. While the State Board
is, in a general way, in charge of all mat-ters
relating to the public health, it has
only advisory powers, and the actual
practical work must be done by the Su-perintendent.
In a word, a county with-out
a superintendent has no sanitary
organization, and the health laws cannot
be applied to its people. In spite of every
effort, until recently, a considerable num-ber
of counties have utterly ignored the
law commanding them to elect a Super-intendent.
For years the number of
counties having Superintendents was less
than 70, then by special effort it was
raised to eighty-odd. At the time of our
last meeting there were eleven counties
having no health officer. The Board, at
a meeting held at the time of the Confer-ence
at Wilson, realizing their utter help-lessness
in case of the introduction of
small-pox, which they anticipated would
become widespread, instructed its Secre-tary
to write to every County Commis-sioner
in the derelict counties individu-ally,
calling attention to these facts, and
urging the importance of the immediate
election of a Superintendent. The Sec-retary
was also instructed to write to the
Judge holding the nearest court in said
counties, asking him to charge the grand
jury on our health law, and to suggest
the indictment of the commissioners re-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 27
fusing to perform their duty. At the
same time, a letter to even* commissioner
in the State setting forth the importance
of making preparations for the probable
appearance of small-pox, was ordered. I
wrote to one Judge, but whether he acted
upon our request or not, I have never
learned. The letters were sent to the
Commissioners and eight new Superin-tendents
were elected, so that now only
three counties—all very small— Camden.
Pamlico, and Tyrrell, have no health of-ficer.
The value of this official is coming
to be more and more appreciated every
day, thanks chiefly to small-pox, and it
is to be hoped that in time, he will be
adequately remunerated for his services.
Some counties, I am glad to say, have
shown a disposition to do this by paying
the Superintendent $10 a day when en-gaged
in small-pox work, although it
must be admitted that more pay less, and
that many add nothing to the regular
pittance.
THE OUTSIDE INSANE.
While the insane constitute a class of
their own under the special care of other
guardians, they cannot be properly ig-nored
in a general consideration of the
public health. Although our State has
made generous provision for these unfor-tunates
in three well-equipped and admi-rably
managed hospitals, the present ac-commodations
are not adequate for the
care of all who need it. Basing an opin-ion
upon the recent excellent report of
the State Board of Public Charities on
this subject, which gives the number of
insane, epilectics and idiots located at
766, it is not unreasonable to assume that
there are at least one thousand of these
stricken ones in jails, county homes and
private families. It would be a work of
supererogation to detail to a body of
medical men, who are only too familiar
with such sad sights, the horrors of the
situation of many of them. No matter
how good the intentions of their keepers
may be, they cannot obtain the care and
attention to which, as a matter of simple
humanity, they are entitled, owing to the
lack of facilities and of knowledge and
experience in this particular kind of
work on the part of those in charge. By
a comparatively inexpensive amplifica-catiou
of our three State hospitals, all of
the insane and mostof the epileptics could
be given expert care and treatment at a
cost, in the aggregate, very much less than
that incurred under the present system.
It is to be hoped that the next Legisla-ture
will take action in this matter, and,
as our law-makers are largely influenced
by public opinion, it seems to me that
the adoption of a resolution setting forth
the views of this body, which represents
the medical profession of the State would
be in order.
PURE FOOD AND DRUG CONGRESS.
By appointment of the President I at-tended,
as a delegate from this Board, the
third annual session of the National Pure
Food and Drug Congress, which was held
at Washington, March 7—9. The meet-ing
was largely attended by representa-tives
of all the interests involved from all
parts of the United States. After a very
full discussion of the relative merits of
two bills setting forth the objects sought,
which had been introduced in the House
of Representatives by the Honorable
Messrs. Brosius and Babcock, respect-ively,
it was decided that the Brosius
bill was the more satisfactory, and it was
adopted as embodying the views and
wishes of the Food Congress. The out-look
for desirable legislation on this line
is said to be favorable, if action can be
obtained at this session. 1 would, there-fore,
respectfully suggest that a resolution
calling attention to the importance of the
28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
subject, and asking the support of the
Brosius bill by our Senators and Repre-sentatives
in Congress be adopted by the
conjoint session and forwarded to them
at once.
small-pox.
The history of small pox in the State
for the past twelve months has been an
almostjexact repetition of that of the pre-ceding
year, in every respect, except the
number of cases, which has been nearly
five times as great.
An exact comparative statement is as
follows:
From January 12, 1898, to May 1, 1899—
Number of cases (in 38 counties), white,
162; colored, 454; total, 610.
Number of deaths, white, 8; colored,
9; total, 17.
Death rate, per cent., white, 4.93; col-ored,
1.97; total, 2.70.
From May 1, 1899, to May 1, 1900—
Number of cases (in'55 counties), white,
731; colored, 2,075: total, 2,800.
Number of deaths, white, 35; colored,
30; total, 65.
Death rate, per cent., white, 4.78; col-ored,
1.44; total, 2.31.
From this'statement it appears that the
proportion between the two races is al-most
exactly the same, the number of
colored attacked'being nearly three times
as large as the number of white in both
periods. The'death rate has remained
also nearly the same—a trifle less—the
decrease being slightly more marked in
the colored race.
The character of the disease has, as a
rule, been very mild, and from that fact
have arisen nearly all the difficulties in
the management; the indifference, and
often positive opposition, on the part of
the people to vaccination: the reluctance
of the authorities to institute and support
effective measures of prevention ; and the
mistakes in diagnosis, including the dis-astrous
effect upon public opinion of the
efforts of the physicians making the mis-takes
to support their position. From
the last of these three things has come
the chief trouble. The matter has been
so fully discussed in various issues of The
Bulletin during the year that I will not
weary your patience by a repetition of it,
but will merely cite two instances: the
counties of Guilford and Rockingham.
In both these counties the disease was
diagnosed chicken-pox by the attend-ing
physician, and in the latter the po-sition
was persisted in, notwithstanding
the opinion to the contrary of an expert.
In consequence, the proper precautions
were not promptly taken, and the result
was, in Guilford 509 cases with 9 deaths,
and in Rockingham 520 cases with 20
deaths, to which should be added the
direct cost to the counties of thousands
of dollars in handling the widespread
epidemics, and the loss of tens of thou-sands
in trade. In justice to the Super-intendents
of both these counties, it
should be said that the harm in the way
of numberless exposures of unvaccinated
persons was done before the disease was
reported to them as small-pox, when
only their responsibilities began. I have
no reason to believe otherwise than that
they are both good men, and efficient
health officers.
The work of our two inspectors, Drs.
Joshua Tayloe, of Washington, and L.
Harrill, of Statesville, wmose reports are
attached, has been of great value in set-tling
disputed diagnoses, instructing
Superintendents new at the business, im-pressing
upon the authorities the gravity
of the situation, and explaining the best
way to meet it.
In response to special requests from
Greensboro, Winston, and High Point,
for a United States expert, I asked Sur-geon-<
General Wyrnan, of the Marine
BULLETIN OF THE NORTH CAROLINA BOARD <>! HEALTH. 29
Hospital Service, to send one of his men
to those points. He promptly granted
my request, and sent Passed Assistant
Surgeon Wertenbaker, whose efforts were
of material aid in setting public opinion
right, and in inaugurating the proper
precautions.
Upon the occurrence of a case of sus-pected
smallpox in one of the students,
I personally visited the University, at
the request of President Alderman and
Dr. Whitehead. I confirmed the diag-nosis
of small-pox already made by Dr.
Whitehead, endorsed the precautionary
measures already planned and in part in-augurated
and addressed the student
body, particularly upon the value and
importance of vaccination. The entire
absence of panic among the 500 students,
and the failure to spread from the first
case under such circumstances, is suffi-cient
testimony to the admirable man-agement
of those in charge there. I also
personally visited Reidsville, at the urgent
and repeated request of Superintendent
Ellington, to aid him in securing the co-operation
of the County Commissioners
with those of the town. I addressed
both bodies in joint session, and was
much gratified to learn that the County
Commissioners took action in the manner
desired immediately upon adjournment.
and to be assured since that my visit was
really helpful.
Owing to the extreme mildness of the
disease in many instances, no physician
has been called in, and absolutely no
precautions in the way of disinfection
have been taken. This means, of course.
a great many foci of infection for time to
come. According to the reports of the
Superintendents, hardly more than 10
per cent, of the people have been vacci-nated
on an average, though it should be
said to the honor of this county of Edge-combe,
whose hospitality we are now
enjoying, that she heads the list in this
good work with 80 per cent of her entire
population, rural as well as urban, vacci-nated.
The conclusion from these two
facts is inevitable. There must be a re-crudescence
of small- pox next winter,
unless the people are generally vaccina-ted
between now and then on a much
more extensive scale. Since the decision
of the Supreme Court, in State Appellant
v. W. E. Hay from Alamance, affirming
the right of county and municipal au-thorities
to enforce compulsory vaccina-tion—
a copy of which opinion, delivered
by Justice Clark, was printed in the
March Bulletin—-there need be no
trouble about it. The responsibility rests
upon the said authorities. Let us hope
they will meet it. And in this connection,
let me say one word as to the duty of the
medical profession in the premises. It
is clear. They should, without ceasing,
teach, preach and practice vaccination,
and cordially support all authorities try-ing
to bring it about.
In conclusion, I would say that the
Board of Health, owing to the small-pox
epidemic and the outbreak of fever at
the Normal and Industrial College, has
never been so much in evidence, and,
apparently, so much appreciated by the
people as during the past year.
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
RECORD OF SMALL-POX IN NORTH CAROLINA FROM MAY 1st, 1899,
TO MAY 1st, 1900.
Counties.
Alamance
Alexander
Anson
Bertie
Buncombe
Burke
Cabarrus
Caldwell
Carteret
Caswell
Catawba
Chatham
Cherokee
Chowan
Cleveland
Craven
Cumberland .
Currituck
Davidson .
Davie
Durham
Edgecombe ....
Forsyth
Gaston
Gates
Granville
Guilford
Halifax
Harnett
Haywood ,
Henderson
Hertford
Iredell
Johnson
Mecklenburg..
Moore
Nash
New Hanover..
Northampton .
Orange
Pender
Person
Randolph
Richmond
Robeson
Rockingham..
Rowan
Rutherford
Stanly
Surry
Utuon.
Vance
Wake
Warren
Washington.
White. Colored. Total. White. I Colored. Total.
15
144
40
1
1
105
30
12
I
1
j
34
•21
19
1
4
8
HHl
44.1
150
24
48
76
24
15
14
24
8
14
7
29
15
376
130
60
s\
12
8
1
26
62
12
30
19
33
61
13
13
1
39
1
95
1
33
13
1
1
24
45
29
21
1
12
8
118
1
509
162
8
32
1
4::
1
39
.50
92
46
16
14
44
8
40
18
29
30
520
170
61
24
117
8
3
31
2
1
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 31
REPORT OF SMALL-POX INSPECTORS.
REPORT OF DR. TAYEuE.
Dr. R. H. Lewis, Secretary,
State Board of Health,
Raleigh, N. C.
Sir:—I submit herewith to the State
Board of Health the following report of
my work as Small-pox Inspector, from
May, 1899, to May, 1900. In this report
I give the towns, counties, number of
cases examined, how managed and by
whom. Also what precautions had been
taken up to my inspection.
May, 1899—I made a trip to Gates
county, this being my first inspection,
examined a good many patients suffering
from the mild forms of small-pox, two-thirds
being white people. There existed
in Gates county, at the time of my visit,
thirty-five infected houses. No precau-tions
had been taken. No superintendent
of health.
May, 1899—I inspected the conditions
in Currituck county. Saw six cases, two
white and four colored, in charge of Dr.
H. M. Shaw, Superintendent of Health.
Some precautions had been taken.
June 23, 1899—Hertford county, at
Ahoskie, I examined three cases, negroes,
in charge of Dr. Tayloe, Superintendent
of Health. They were well cared for.
Scotland Neck, Halifax County—
Five cases were examined by me, all
negroes. More negroes afterwards de-veloped
the disease, also some whites.
No precautions had been taken until the
time of my inspection, as a positive diag-nosis
was not made until then. Dr.
Green, Superintendent of Health, then
took charge, and with the assistance of
Dr. Wimberley, managed the cases well.
June ?>, 1899
—
Beaufort, Carteret
County—Examined one case, white.
Well managed by Dr. Frank Clark,
Superintendent.
March 29, 1900—Robeson County—In-spected
eight cases, five white and three,
colored. Some precautions had been
taken. Drs. McNatt and Utley in charge.
Henderson, Vance County—I inspect-ed
one case, white. All necessary pre-cautions
had been taken by Drs. Cheat-ham
and Bass, Health Officers.
April 1, 1900—Selma, Johnston
County—Thirteen cases were inspected
by me, seven white and six colored. Of
these two suffered with confluent type,
one died. Moderate precautions had
been taken by Drs. Wharton and Noble,
health officers of county and town re-spectively.
April, 1900—Franklin County—In-spected
four cases, all colored. Proper
precautions were at once taken by Dr.
Foster, Superintendent.
Small-pox has existed during this epi-demic
in all its forms, from the mildest
varioloid to the most malignant confluent
type, as expressed by Dr. Long.
In every town and county in which 1
made inspections I made reports to the
Town and County Commissioners and
Local Health Boards, advising them as to
the best possible means of stamping out
and controlling the disease, without
further spread. Also described the full
technique of caring for patients and
handling suspects, suggesting as thorough
vaccination as possible in every section
which I visited.
I advocate vaccination because I believe
it to be the most powerful means of pre-venting
the disease. I regard vaccine
virus as the most active material that can
be admitted into the list of our prophy-lactic
remedies, and the only weapon of
defence in overcoming the worst of
human maladies.
The large majority of small- pox in the
State has existed in a very mild type, in
fact, the virtue of vaccination has so
32 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
modified the disease that it is only in
exceptional cases we have the oportunity
of studying the malignant forms. I have
had the oportunity in the present epi-demic
to examine only a few cases of the
malignant forms of small-pox, and I am
firmly of the opinion that such types of
the disease can only exist in those who
are absolutely without history of vacci-nation,
and I mean by that, those whose
parents and grandparents have not been
vaccinated.
The protective influence of vaccination
is so great that, from my experience, I
am willing to assert that the vaccinated
can only contract the disease by close and
continuous contact or exposure. And if
contracted then, it is of a mild and modi-fied
form.
Respectfully submi tted
Joshua Tayloe, M. D.,
Small-pox Inspector.
Washington, N". C, May 21st. 1900.
REPORT OF DR. HARRII.L.
Statesyille, N. C, May 19, 1900.
Dr. R. H. Lewis, Secretary,
State Board of Health.
My Dear Doctor: —-At your request I
hereby submit a statement of visits made
by me as Inspector. My appointment
was made about the middle of January
fest.
January 20—I visited New London,
Stanly county, where I found seven cases
of small-pox, colored.
February 4—At Thomasviile, I saw two
eases, colored.
February 10—At Asheville, I saw twelve
cases, whites.
February 20 to 22—Near AValnut Cove,
Stokes county, saw two cases besides six
or eight others recovered, and in the
same county, at Pinnacle, saw three cases.
A local doctor refused to accept my diag-nosis.
The leading case, and the one
upon which I based my opinion, was in
a woman, forty to forty-five years of age.
with an eruption about nine days old
when I saw her. The cases at Walnut
Cove and Pinnacle all white people.
February 23—I saw one case at Pilot
Mountain. I visited Reidsville and saw
the celebrated cases in a seminary there.
I have been informed that persistant
efforts were made by a local physician to
discredit my opinion. Repeated vacci-nations
were made, but without results.
I am informed that one of the patients
afterwards carried the contagion to her
home in some of her clothing, and from
this source there were two malignant
cases resulting in death. I saw in Reids-ville
twelve to fourteen cases, but the
actual number at that time was probably
three or four times as many.
February 24—Visited Hillsboro. Saw
two cases.
March 2—Visited Taylorsville and
found six cases, all whites Dr. H. F.
Long also saw one of these cases, and
confirmed my diagnosis.
March 24—I visited Jonesboro and
found six case- in one family, all white.
The mother and grandmother in the same
house had both been vaccinated when
young, and both escaped the disease. I
saw one other white man and two negroes
with the disease.
Ai'Kii. 16—Visited Shelby and found
six cases in the same family of negroes.
Another family of negro children had
chicken-pox. AtFallston, in same county,
1 saw one case in a white man. At
Mooresboro, one case, a negro man. Near
Cleveland Springs, same county. I saw-one
case, a negro woman.
April 27—Visited Henrietta. Ruth-erford
county, where I saw three cases,
all negroes. One case reported at Caro-leen,
and one west of Rutherfordton that
I did not -
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33
April 30—Visited Spray and saw three
cases, all whites, besides several recovered
and convalescent cases that I believe were
the same disease.
May 1—Visited Madison and found that
small-pox had been there four to sis
weeks. I saw one partly confluent case
here. There had been in all about fifteen
cases.
May 2—Visited Stem, Granville county,
and found one case only developed, but
a number of exposures.
This closes my list of official visitations.
There is a strong prejudice against vacci-nation,
and decided opposition to any
restriction or isolation of patients. Also
a determination to not believe there is
any small-pox in the State. Unfortu-nately
this belief extends to some of the
doctors, and when one or more of that
kind are in a community it is almost im-possible
to control the disease. I per-suaded
one doctor, a non-believer in vac-cination,
to go with me within thirty or
forty feet of a- well developed case. After
seeing it. he decided that as be was
practising in the neighborhood, and had
never been vaccinated, lie ought to be.
In communities where the disease has
been for several months, it is to be feared
that there is already, and will continue
to be. a relaxation of proper efforts to
stamp out the disease.
Public meetings have been called in
many places, and I have tried to advise
the people about vaccination and other
neccessary regulations. Hoping this im-perfect
report will be satisfactory, I re-main.
Yours very truly,
L. Harrill, M. 1> .
Smallpox Inspector.
RESO] UTIONS ADOPTED.
The following resolutions were adopted
by the Conjoint Session of the Shite Board
of Health and the State Medical Society:
IN REGARD TO PURE FOOD, BY COL. A. W. SHAFFER.
Whereas, The health of the people is
largely dependent upon the purity of
their food and the reliability of their
medicine, and is injuriously affected by
the adulterations now so common in very
many of the articles in daily use; and
Whereas, A bill to prevent such inju-rious
adulterations, introduced by the
Hon. Mr. Brosius, is now pending in
Congress; therefore be it
Resolved, by the North Carolina Board
of Health and the Medical Society of
the State of North Carolina, in conjoint
session assembled, that our Senators and
Representatives in Congress be requested
to give this measure their prompt and
cordial support,
IN RECiARD TO OUTSIDE INSANE, BY I'll. HENRY
\Y. T.KWIS.
Whereas, Recent official reports from
the State Board of Charities show that
there are in North Carolina, uncared for
in asylums or other proper institutions,
insane, epileptics and idiots to the num-ber
of 766, and that there are probably
as many more in the State who have not
been reported; and
^Yuereas, It is a notorious fact that
many of these people are confined in jails
and county homes without proper care
and attention, and undergo hardships
and in many cases maltreatment—which
of itself precludes the hope of improve-ment
or recovery from their mental or
physical condition; therefore be it
Resolved, 1st. That the paramount con-sideration
is that these patients have
proper treatment at the hands of the
State of North Carolina, whereby the re-proach
now resting on US may he removed.
2d. That it being notorious that the
State institutions are already overcrowd-ed,
we urge the pressing necessity of such
early increase of hospital facilities as will
insure these proper care and treatment,
34 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
and to this end we commend the plan
referred to by Dr. P. L. Murphy, in his
paper read before the students of the A.
& M. College at Raleigh, March 16, 1900—
said plan being known as "The Cottage
System."
IN REGARD TO SMALL-POX, BY DR. B. WESTRAY
BATTLE.
The total number of cases of small-pox
in the State for the year from May 1, 1899,
to May 1, 1900, was 2,806, as against 616
for the fifteen and a-half months prece-ding—
from the beginning of the epidemic
on January 12th, 1898, to May 1st, 1899,
an increase of 455.5 per cent. This means
innumerable foci of infection, which
in an indefinite number of instances,
owing to entire neglect or imperfect prac-tice
of disinfection, are and will continue
for months or years still active. Reports
from Superintendents of Health show, on
an average, about 10 per cent, only of the
people as being vaccinated. The people
seem to be general^ indifferent or ac-tively
opposed to vaccination. The au-thorities,
county and municipal, except
in the actual presence of small-pox, do
not appear to realize the gravity of the
situation and the dangers which menace
their people. In view of these facts,
be it
Resolved, by the North Carolina Board
of Health and the Medical Society of the
State of North Carolina, in conjoint ses-sion
assembled, that it is their opinion
that in the present conditions the con-tinued
spread of small-pox is inevitable,
with the strong probability of its reach-ing
pestilential proportions during the
coming winter, small-pox being much
more virulent in cold weather;
That quarantine and disinfection in
the present state of public opinion, and
in view of the lukewarm support, to say
the least, too often given the health offi-cer,
cannot be depended upon to prevent
the spread of the disease;
That the thorough and complete vacci-nation
of all the people is alone adequate
to meet the situation;
That this, in most instances can only
be accomplished by compulsion, legal
authority for which has been affirmed in
the recent decision of our Supreme Court
in State v. Hay;
That we feel it to be our duty to notify
the people of these facts, and the grave
dangers which threaten them, and to call
upon those who represent their interests,
the various boards of county commission-ers,
boards of city aldermen and town
commissioners to take at the earliest prac-ticable
moment the necessary steps to
secure the vaccination of the people, and
we urgently appeal to our professional
brethren throughout the State, individ-ually,
as well as collectively, to render
every aid in their power, by both word
and act, to the accomplishment of this
most important object.
A resolution in favor of establishing
the Appalachian Park was introduced
and adopted, and copies ordered sent to
our Senators and Representatives.
Death of Dr. Cheatham.
It is with much regret that we chronicle
the death on the 23d instant of Dr. "VV. T.
Cheatham of Henderson. Dr. Cheatham
was one of the prominent physicians of
the State, having been for many years a
leading practitioner in his community,
and in 1892 President of the State Medi-cal
Society. At the time of his death he
was Superintendent of Health of his
county.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 35
Review of Diseases for May. 1900.
EIGHTY-SIX COUNTIES REPORTING.
Ninety-three counties have Superinten-dents
of Health.
Except in the case of the more con-tagious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of May the following
diseases have been reported from the
counties named
Measles.—Alamance, 30 ; Ashe, 6
Bertie, general ; Bladen ; Brunswick,
3 ; Caldwell, 1 ; Caswell, several ; Chero-kee,
many ; Chowan, 3 ; Clay, 1 ; Cleve-land,
a few; Columbus; Craven, 24;
Currituck, 2; Dare, epidemic, severe;
Forsyth, general; Gates, 20; Granville,
10 ; Greene, 100 ; Halifax, 10 ; Harnett,
a few ; Hertford, 4 ; Hyde, 1 ; Johnston,
14 ; Martin, 50 ; Moore, 4 ; Nash, epi-demic
; New Hanover, 170; Northamp-ton,
many ; Onslow, 3 ; Pasquotank, 25
Pender, 6 ; Perquimans, 26 ; Pitt ; Robe-son,
epidemic ; Rockingham ; Surry, 6
;
Swain, 12; Wake, 43; Washington, 44;
Watauga, general—41 counties.
Whooping-cough.—Beaufort, 3; Burke,
8 ; Cabarrus, many ; Caldwell, 10 ; Cleve-land,
a few ; Columbus ; Craven, 25
Currituck, 7 ; Gates, 20 ; Graham several
Granville, 10 ; Greene, 50 ; Halifax, 15
Hertford, 3 ; Jones, several ; Macon
Madison, 50; Martin, 50; Mecklenburg,
15 ; Nash, epidemic ; New Hanover, 6
;
Perquimans, 2 ; Richmond, many ; Wake,
25; Washington, 2; Watauga, general
—
26 counties.
Scarlatina.—Craven, 1 ; Rockingham.
Diphtheria.—Pitt, 1.
Typhoid Fever.—Alamance, 7 ; Ashe,
3; Beaufort, 2; Burke, 4; Chowan, 2
Craven, 2; Currituck, 2; Halifax, 2
Harnett, a few ; Haywood, 4 ; Johnston
3 ; Macon, 1 ; Mitchell, a few ; Nash, 1
Onslow, 1 ; Pender, 1 ; Perquimans, 2
Pitt, 1 ; Richmond, 1 ; Rockingham
Union, 3 ; Wake, 3 ; Watauga, 1 ; Wayne,
1 ; Wilson, 1—25 counties.
Malarial Fever.—Alamance, Cabar-rus,
Currituck, Dare, Gaston, Halifax,
Hertford, Johnston, Jones, Martin, Ons-low,
Orange, Perquimans, Person, Wash-ington,
Wayne, Yadkin—17 counties.
Malarial Fever, Pernicious.—Johns-ton,
4 ; Jones, 2.
Malarial Fever, Hemorrhagic.—
Hertford.
Influenza.—Bladen ; Brunswick, gene-ral
; Cleveland ; Graham ; Lenoir ; Lin-coln,
general ; McDowell ; Mecklenburg
;
Onslow; Pitt; Randolph, epidemic;
Sampson ; Transylvania ; Wake ; Wilson,
general—16 counties.
Pneumonia.—Brunswick ; Cherokee ;
Gates, much, of severe type ; Jackson
Lenoir ; Pitt ; Randolph ; Wilson ; Yad-kin—
9 counties.
Diarrheal Diseases.—Bladen, Bruns-wick,
Burke, Cabarrus, Chatham, Colum-bus,
Currituck, Dare, Davidson, Gaston,
Granville, Greene, Halifax, Hertford,
Jones, Lincoln, McDowell, Mecklenburg,
Moore, Northampton, Onslow, Pender,
Perquimans, Person, Pitt, Robeson, Rock-ingham,
Rutherford, Surry, Transylvania,
Union, Vance, Wake, Wilkes—34 coun-ties.
Mumps.—Sampson, Watauga, Yadkin.
Roseola.—Lincoln, epidemic.
Rotheln. —Sampson.
36 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Small-pox.—Alamance, 2 ; Burke, 12 ;
Cabarrus, 3 ; Caswell, 10 ; Chatham, 1
;
Cleveland, 5 ; Davidson, 1 ; Davie, 9, one
a child five weeks old ; Durham, 8 ; For-syth,
8; Franklin, many, of mild type,
in one section, no new cases for several
weeks ; Granville, 21 ; Guilford, 22 ; Hali-fax,
1 ; Haywood, 5 ; Henderson, 4 ; Hert-ford,
1 ; Johnston, 16 ; Mecklenburg, 20
;
Nash, 2 ; Orange, 7 ; Person, 4 ; Randolph,
3 ; Rockingham, 131 ; Rutherford, a few
—
25 counties.
Cholera in Fowls.—Chatham.
Cholera -in Swine.—Hyde.
Distemper in Dogs —Jackson.
Distemper in Horses.—Ashe, Burke,
Cleveland, Macon, Swain.
Hydrophobia in Dogs.—Ashe.
No diseases are reported from Alexan-
Buncombe, Carteret, Edgecombe, Iredell,
Warren and Yancey.
No reports received from Alleghany,
Anson, Cumberland, Duplin, Mont-gomery,
Rowan and Stanly.
Summary of Mortuary Reports for
May, 1900.
(eighteen towns).
Only those towns from which certified
reports are received are included.
White. Col'd. Total.
Aggregate popula-tion
70,901 51,599 122,500
Aggregate deaths... 60 103 163
Representing tem-porary
annual
death rate per
1,000 10.1 23.9 15.9
Causes of Death.
Typhoid fever 12 3
Malarial fever 112 Whooping cough... Oil Measles 4 4
Pneumonia 5 7 12
Consumption 9 18 27
Brain diseases 2 13 Heart diseases 14 5
Neurotic diseases... 11 Diarrhceal diseases 7 S 15
All other diseases.. 33 53 86
Accident 134
60 103 163
Deaths under five
years 23 28 51
Still-born _ 7 9 16
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 37
Mortuary Report for May, 1900.
'OPULA-rios.
temporary
Annual
Death PiATE
PER 1,000. - Q S
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. R. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J. Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. J. W. Sain.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell.. Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-ly
°
house.
Polk Dr. Earle Grady.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland
Stanly Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. J. J. L. McCullers.
Warren Dr. T. B. Williams.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. William Spicer.
Wilkes Dr. J. W. White.
Wilson Dr. W. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancey Dr. W. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 39
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks: __. _
M. J).
190.— N. C.
BTTX-.X-.ETXILT
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary mid Treasurer, Raleigh.
Vol. XV. JULY, 1900. No. 4.
Mosquitoes and Malaria.
Read before the Raleigh Academy of Medicine by
Gerald McCarthy, Entomologist of the N. 0. De-partment
of Agriculture.
It is scarcely necessary, before an au-dience
like the present, to allude to the
scourge-like character of malaria in all
warm moist countries.
Malaria we know to be a germ disease.
The specific germ causing malaria in
humans was first described by Laveran
in 1880. Subsequently other investiga-tors,
chiefly in Italy, took up the study
of the etiology of the disease. Golgi,
in 1885, found what he supposed was the
same parasite in the blood of birds suf-fering
from fever. The German Koch,
and other of his countrymen, have ad-ded
much valuable work, but it is to the
British army surgeon, Ronald Ross, that
we owe the final clearing up of the sub-ject
and a most convincing demonstration
of the method in which malaria is spread.
It is well known, alike to the medical
profession and to laymen, that most
swampy regions in warm countries are
malarious in summer time. It is said in
a loose sort of way that such swamps
breed malaria. But we know that ma-laria
is due to a protozoan parasite in the
blood stream. This parasite has never
been isolated from swamp or any other
natural water. According to the re-searches
of Ross and numerous collabo
rators in Italy and Germany, the parasite
of human malaria is never found but in
the human body and in certain organs of
mosquitoes of the genus anopheles. Ross'
work is not a year old. It has created a
most profound sensation among economic
entomologists and those who have to do
with public health.
Entomologists are now busy in most
regions where malaria is endemic in
studying the species of anopheles found
therein. So far publications show that
this genus is very poor in species, and
that the number of individuals belong-ing
to any species of anopheles ia in any
particular region few in comparison with
the individuals of the genus culex. < 'id, x
is everywhere the common mosquito. It
is concerned in spreading the malarial
42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
disease of birds, but so far, the parasite
of human malaria has not been found in
any species of culex. Before we go
further, I may say that entomologists
classify mosquitoes into five genera, of
which three are rare and of no economic
importance. The remaining genera are
culex, of which we have in the United
States about twenty-two species, of which
seven are known in North Carolina. Of
anopheles we have in the United States
only three species, so far as known. All
three of these occur in North Carolina.
If I should go out and capture 1,000
mosquitoes anywhere in this v : cinity,
from 900 to 999 of them would probably
belong to culex, the remainder to ano-pheles.
Now as to the method in which the in-sect
propagates the parasite. It would
seem reasonable that if a drop of human
blood containing the malarial parasite
be injected into a vein of a healthy per-son,
not immune, the parasites will mul-tiply
in the body of the new host and
produce malarial fever of the same va-riety
as in the person from whom the
blood was taken. Therefore any insect
whatever which should suck the blood
of a malarial patient may transmit the
disease by afterwards puncturing a blood
vessel of another person. In practice,
however, it is found that malaria is not
transmitted in this way by any mosqui-toes
except anopheles. It seems that
the protozoans, which adhere to the
puncturing apparatus of the insect, rap-idly
perish in the free air and are dead
before the insect finds an uninfected per-son
to bite.
The parasites of human malaria exist
in the blood stream at first in the form
of amoeboid, motile jelly dots. They
grow fast and usually in from one to three
days attain full size. They then pass
into the spore form as sporocytes and
gametocytes. The sporocyte is the asex-ual
form. It at once begins to form a
sort of capsule in which appear asexual
spores. These spores, according to the
species, mature in from one to three days.
The capsules then burst, the spores fall
into the serum and soon after assume the
amoeboid form. They move about in
the blood serum until they find a red cap-sule
to attack. The bursting of the spore
sacks and the storming of the blood cor-puscles
by the new generation of proto-zoans
is correlated to the period of recur-rence
of the fever, and is the cause of the
same.
The gametocytes are the sexual form.
They do not undergo any further change
in the human body except as they may
degenerate and die. They may, in this
way, circulate in the blood stream for
days and weeks. If a mosquito of the
genus anopheles sucks the blood of a
person in whose blood stream the game-tocytes
are circulating the cysts as soon
as they reach the fore crop of the insect
burst. The microbe resumes the cycle
of its development. Some of the cysts
produce male, some female germs. These
coalesce and the result is a new individ-ual
or zygote. These grow rapidly, are
very active and repel the attacks of the
phagocytes of the human blood in which
they were borne into the alimentary tract
of the insect. The zygotes soon bore
through the stomach walls of the mosqui-to
and fix themselves upon the external
surface in the form of oval cells of from
8 to 10 micromillimeters in diameter.
These cells subdivide much like the egg
of a vertebrate, and eventually form a
capsule full of small spores—each cap-sule,
when mature, is 60 micromillime-ters
to 80 micromillimeters in diameter,
and may contain several thousand spores.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 43
The whole process from the time the
gametocyte enters the body of the insect
until the spores are formed is about ten
to twelve days in summer. It is longer
in cooler weather. These sexual spores are
motile and move about until they reach
the blood stream of the insect. In this
they are carried into the salivary glands.
AVhen snch a mosquito bites a person she
injects into the wound some of the saliva
and with it the spores of the proto-zoan.
These once in the human blood
stream assume the amceboid form from
which we started, and so begins a new
cycle.
It may be asked what becomes of ga-metocytes
which do not find their way
into the body of an anopheles. They
eventually degenerate and are eaten by
the phagocytes. The same fate, sooner
or later, overtakes the sporophytes in the
human blood. If, instead of anopheles,
it is culex, which receives the gameto-cytes,
so far as we know, the latter do
not develop further but are digested with
the blood in which they are imbedded.
Now a few words as to the classification
of the protozoan parasite.
The latest authors make two genera:
I. Htemamcebidse.
II. Hsemomenas.
The first genus contains four species.
Two of these produce malaria in birds.
The other two in man.
Hiemamceba malarias, causes quartan
fever.
Hsemamoba vivax causes tertian fever.
Hsemomenas has but one species.
H. pr:ecox (Laverania malarhe of older
authors).
It causes pernicious autumn malaria
in man.
The life histories above outlined are
not based upon theory, but upon micro-scopic
dissections. They are as true as
anything can be in science.
So much for the scientific portion of
our theme. Now for some practical ap-plications.
It is apparent, in the light of the new
knowledge, that too much stress has been
laid by hygienists upon the value of pure
water as a preventative of malaria. Since
the germ does not usually or at all exist
in water, it is, so far as this point is con-cerntd,
of no importance what one drinks.
It is certain that mosquitoes do die and
fall into wells and tanks, and when the
body dissolves the contained protozoans
will be set free. But we have seen that
the protozoan can exist very briefly, or
not at all, in air, and the same condition
will hold good as regards water. More-over
the anopheles mosquitoes never
breed in reasonably clean watei", or in
wells, tanks, or water barrels. They are
a peculiarly wild and ferocious race.
They breed only in retired pools which
are full of algse and aquatic plants. Rice
fields and sluggish streams, with numer-ous
permanent pools or holes, such as
we find along Walnut creek, are the
favorite breeding places of the anopheles
mosquitoes.
There is a wide-spread idea that the
tearing up of surface soil in hot weather
produces malaria. This cannot be true,
if by malaria we mean the specific dis-ease
due to the presence in the blood of
hsemamabida or hsemomenas. These
parasites do not exist in the soil, nor does
the mosquito, which harbors them, exist
there. *
It may be that several distinct diseases
are confused and included under the com-mon
name of malaria, or it may be that
impure water or emanations from freshly
turned soil break down the resist ing
power of the body against the parasite.
But since exhaustive and fully competent
research has failed to show the presence
44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
of the protozoan, either in the water or
soil of notoriously malarious neighbor-hoods,
it is neither scientific nor just to
say that either soil or water can cause the
disease.
The second point to be emphasized, is
this:
Very few mosquitoes live over winter.
These few hibernate as adults. It is pos-sible
that some of these hibernating mos-quitoes
harbor the sexual spores of ano-pheles,
and may be able to start a new
epidemic of malaria the succeeding sum-mer.
But if this was the only way the
protozoans could pass from one warm
season to another the disease would die
out in many localities. The more com-mon
way of passing the cold season by
the parasite is, as spores in the blood of
persons who had acute malaria the preced-ing
summer. The spores are well known
to be very sensitive to the destructive pow-er
of quinine and methylene blue. If all
convalescents from summer or autumn
malaria were isolated or treated during
the winter with enough quinine or me-thylene
blue to kill the spores in their
blood streams the mosquitoes of the next
season would find no parasites to dissem-inate
and malaria must die out.
Of course the destruction of the pro-tozoans
in any section will not entail any
trouble upon the mosquitoes. The latter
are as much the victims of the parasite
as are mankind. To keep the malarial
parasite out we would have to quarantine
against every outsider not having a cer-tificate
of freedom from the parasite.
One infested person might start an epi-demic
and undo all the work of clearing
it out before.
Another point to be brought out is,
that mosquito screens upon doors and
windows and mosquito netting over beds
should form a part of all prescriptions
for epidemic malaria. The use of unguents
on the exposed parts of the person and
of smudges in or about the houses are
valuable preventives.
The best repellant for mosquitoes is
oil of pennyroyal. This may be mixed
in proportion of one part oil to fifteen or
twenty- five parts of lard or vaseline and
rubbed on hands, arms, neck and face.
The odor of pennyroyal is very persist-ent,
and a little will suffice. A small
uncorked phial of the same is a good
thing to keep in sleeping-rooms at night.
A strong onion, or, what is much better,
a clove of garlic, rubbed on hands and
face is very effective against mosquitoes.
Finally we come to the question of de-stroying
the mosquitoes, who are the
innocent agents for disseminating the
malarial parasite. It seems to me that
the reduction of the members of these
insects to the point of practical harmless-ness
is not only possible, but, when com-pared
with the cost of suffering and
treating malaria, comparatively small.
Since anopheles breeds only in remote
permanent pools or holes, we must seek
these out and with oil kill the breeding
larva-. I am personally of the opinion
that three-fifths or more of all the ano-pheles
mosquitoes bred in Raleigh town-ship
are produced in the holes made along
Walnut creek by the X. C. Penitentiary
in taking out clay to make brick. If
these holes were filled up or their surfaces
kept covered with a film of crude petro-leum,
there would be a very great reduc-tion
in the number of mosquitoes which
carry malaria. The filling up of mud
holes along Walnut creek and around the
rock quarry would do most of the rest.
In proposing to President Goodwin to
bring this subject before the Raleigh
Academy of Medicine, it was my inten-tion
to ask the Association to appoint a
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45
committee to study the mosquito-malaria
theory from a local and experimental
stand-point. I hoped to be able to assist
in the microscopic dissections and make
specific identifications. But since then
changes have occurred which will proba-bly
cause my services to be transferred
to another field after September 1st, and
I shall be unable to follow up the matter
as I proposed. I have gathered numer-ous
testimony as to the relationship
between the mosquitoes named and mala-ria.
Personally, I am entirely convinced
that the relationship is real. This being
so, it seems to me to be well worth the
trouble and cost to make a practicable
trial of the measures I have suggested
for reducing the numbers of the parasite-harboring
mosquito.
I trust that the physicians of this city
and State will exert their influence upon
those who have the appointing power to
make some provision for making investi-gations
along this line. And such inves-tigations
to be of any value must be
based upon and bolstered by real work,
not talk or hearsay.
We are glad to have the privilege of
printing this very interesting paper of
Mr. McCarthy's, but we are not yet pre-pared
to accept all his statements, no
matter how accurate and scientific they
may be. We are a thorough believer in
the mosquito theory of malarial trans-mission,
but we still believe in the drink-ing
water theory, which Mr. McCarthy
flatly denies. The connection between
drinking water and malarial diseases is
so plain and so strong that it simply can-not
be ignored or broken. Knowing that
the female mosquito, the blood-sucker,
laid her eggs on the surface of stagnant
water, immediately died, sank to the
bottom and disintegrated, thereby liber-ating
in the water the germs of malaria;
and knowing that according to over-whelming
evidence persons drinking the
water of shallow, open wells, are much
more subject to malarial diseases than
other persons in identically the same
environment in every single respect, ex-cept
water, drinking the water of cis-terns,
driven pumps or bored wells, we
reconciled the two theories by taking it
for granted that the malaria-bearing
mosquito poisoned in the manner indi-cated
the shallow open wells.
Some years ago, as most of our readers
probably remember, the Board distrib-uted
widely throughout the malarious
sections of the State a pamphlet, entitled
"Drinking Water in its Relation to Ma-larial
Diseases," in which a large amount
of evidence showing the connection was
given. This pamphlet, we are gratified
to know, has borne abundant fruit in an
improvement in the domestic water sup-ply
in innumerable instances, with a
corresponding improvement in health as
regards the diseases of this class. Many
physicians in those localities scoff at the
assertion that malaria is not conveyed by
drinking water, for, as Uncle Remus
would say, " dey dun had de spe'unce
un it."
Mr. McCarthy meets the overwhelming
evidence in support of the drinking
water theory by saying that there may be
other diseases presenting identically the
same clinical features, but lacking the
Plasmodium in the blood. This of course
is a mere assumption—an assumption
that we believe would be disproved by
the microscope. Practically, however, it
is a matter of no moment whether the
parasite can be demonstrated in the blood
or not, if the clinical symptoms are iden-tical
and the remedy is the same. It
seems to us that before the mosquito
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
theory can be regarded as meeting all the
conditions the connection between the
mosquito and drinking water must be
established.
In reply to an inquiry as to how to
distinguish between the cule.% and the
anopheles varieties, Mr. McCarthy stated
that the simplest way was to observe
their behavior in stinging—that the culex,
or domestic mosquito, took his meals
squatting or sitting down, while the ano-pheles
regaled himself standing on his
head. So, that when we see a mosquito
with his bill in our skin and his heels in
the air we may know that he is a " wild
and ferocious" anopheles, and look out
for chills.
It is not our desire or intention to be-little
in any way the mosquito theory. As
we said in the beginning, we thoroughly
believe in it, considering it as practically
demonstrated, and therefore we desire
to endorse Mr. McCarthy's suggestions as
to wire screens, mosquito nets and the
drainage or covering with oil, during the
breeding season, of all stagnant pools.
Attention to these precautions and to the
character of the drinking water would,
in our judgment, reduce malarial dis-eases
to a minimum.
We would be greatly obliged to our
physicians in the malarial regions if they
would write us their experience and their
views on this subject.
The Iowa Way.
The State Board of Medical Examiners
has notified three Iowa physicians to ap-pear
before it at the meeting of the Board
to be held in August to show cause wrhy
their certificates should not be revoked
for incompetency, in failing to recognize
and properly diagnose and report infec-tious
diseases, in consequence of which
the efforts of the State and local boards
of health to protect the people were de-feated;
the diseases were disseminated;
and lives were lost.
American Public Health Association.
Please make notice in your next issue
that the date of the next meeting of the
American Public Health Association at
Indianapolis has been changed to Octo-ber
22, 23, 24, 25, 26. The meeting of the
Section of Bacteriology and Chemistry
will be held Monday, October 22d, in the
Pathological Laboratory of the Central
Insane Hospital at Indianapolis, called
to order at 10 a. m.
The meeting of the regular Association
will open Tuesday, October 23d, 10 a. m.
in Amphitheatre of the German House.
J. N. Hurty,
Local Secretary.
Review of Diseases tor .Tune, 1900.
EIGHTY COUNTIES REPORTING.
Xinety-three counties have Superinten-dents
of Health.
Except in the case of the more con-tagious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of June the following
diseases have been reported from the
counties named
:
Measles.—Alamance, 25; Ashe, 8; Ber-tie,
many; Burke, 3; Cabarrus, 9; Cald-well,
5 ; Carteret ; Cherokee, many ;
Chowan, 4; Clay, several; Columbus,
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47
epidemic; Craven, 45; Cumberland, 5;
Dare, epidemic ; Davidson ; Franklin ;
Granville, 8; Greene, 10; Halifax, 25;
Harnett, 15; Hertford, many; Hyde, 3;
Iredell, 12; Macon, 2; Martin, 50; Meck-lenburg,
10; Nash; New Hanover. 160;
Pasquotank, 25; Pender, epidemic; Robe-son,
a few; Rockingham; Rowan, 50;
Rutherford, a few; Sampson, several;
Wake, 13; Washington, 250; Watauga, a
few—38 counties.
Whooping-cough.—Brunswick; Burke,
epidemic ; Cabarrus, many ; Carteret
;
Cherokee, many; Craven, 31; Cumber-land,
10; Franklin ; Graham, several
Granville, 10; Greene, 15; Jones, several;
McDowell, 5; Macon; Martin, 50; Nash;
New Hanover, 12; Richmond, many;
Transylvania, 5; Watauga, a few—20
counties.
Sc \klatina.—Richmond, 5.
Typhoid Fever.—Alamance, 3; Alex-ander,
1; Ashe, 1; Beaufort, 3; Burke, 5;
Cabarrus, 0; Caldwell, 4; Catawba, 1;
Chowan, 2; Clay, 2; Craven, 16; David-son,
a few; Gaston, 3; Granville, 1;
Greene, 2; Halifax; Harnett, a few; Ire-dell,
8; Jackson, 5; Jones, 2; McDowell,
3; Macon, 2; Madison, 2; Martin, 6;
Mecklenburg, 4; New Hanover, 12;
Orange, 1; Pender, 3; Polk, 1; Randolph,
5; Richmond, a few; Robeson, several;
Rockingham; Rowan, 12; Rutherford, a
few; Union, 4; Wake, 15; Warren, a few;
Wilkes; Yadkin—40 counties.
Malarial Fever.—Bladen, a few; Ca-barrus;
Caswell; Gaston; Gates, a few;
Greene, general; Halifax, general; Har-nett;
Hertford; Iredell; Jones; Lenoir;
Martin, general; Person; Randolph;
Richmond, a few ; Robeson ; Rowan ;
Sampson; Wilson—20 counties.
Malarial Fever, Pernicious.—Hert-ford,
1 ; Jones, 1.
Malarial Fever, Hemorrhagic.—Ca-barrus,
1 ; Hertford, 1.
Influenza.— Brunswick ; Cleveland ;
Randolph; Sampson; Stokes, general.
Diarrhoeal Diseases, including Dys-entery.—
Ashe, general; Bertie, general;
Bladen; Burke, general; Cabarrus; Ca-tawba;
Dare, general; Gaston, a few;
Gates; Graham; Granville; Halifax, gen-eral;
Haywood; Henderson, general; Mc-
Dowell; .Martin; Person; Polk, several;
Richmond; Robeson; Rockingham, gen-eral;
Union; Wake, general; Yadkin,
general—24 counties.
Mumps.—Martin, general; Moore, 3.
Pneumonia.—Lenoir.
Yaricella.—Caswell.
Small Pox.—Buncombe, 5; Burke, 10;
Cabarrus, 2; Caswell, 9; Craven, 10; Dur-ham,
2; Fdgecombe, 2; Gates, 1; Gran-ville,
4; Harnett, 8; Hertford, 1; Iredell,
5; Johnston, 1; Mecklenburg, 15, in
northeastern part; Moore, 14, confined to
two houses; Nash, 3; New Hanover, 7;
Randolph, 5; Rockingham, 21-19 counties.
Cholera in Chickens. — Alamance,
Graham.
Cholera in Hogs.—Bertie, Graham,
Jackson, Moore.
Distemper in Horses.—Ashe.
No diseases are reported from Chatham,
Davie, Lincoln, Mitchell, Northampton,
Pitt, Yance and Yancey.
No reports received from Alleghany,
Anson, Currituck, Duplin, Forsyth, Guil-ford,
Montgomery, Onslow, Perquimans,
Stanly, Surry, Swain and Wayne.
Summary of Mortuary Reports for
June, 1900.
(twenty towns).
Only those towns from which certified
reports are received are included.
White. CoVd. Total.
Aggregate popula-tion
86,501 59,549 146,050
Aggregate deaths... 108 89 197
Representing tem-porary
annual
death rate per
1,000 14.9 17.8 16.2
Causes of Death.
Typhoid fever 4 15 Malarial fever 2 3 5
Whooping cough... Oil Measles 2 1 3
Pneumonia 3 4 7
Consumption 7 7 14
Brain diseases 5 16 Heart diseases 6 '> 12
Neurotic diseases... 2 3 5
1 liarrhceal diseases 22 13 35
All other diseases.. 52 48 100
Accident 3 3
Yiolence 11
108 89 197
Deaths under five
years 40 28 68
Still-born - 4 4 8
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 49
County Superintendents of Health.
Alamance Dr. T. S. Fancette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dnnstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. R. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. 8. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuYal Jones.
Cumberland Dr. J.YanceMcGougan.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. J. AV. Sain.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland
Stanlv Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. J. J. L. McCullers.
AVarren Dr. T B. AVilliams.
AVashington Dr. W. H. AVard.
AVatauga Dr. E. F. Bingham.
Wayne Dr. AVilliam Spicer.
AVilkes Dr J. AV. AVhite.
AVilson Dr. AV. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancey Dr. AA
T
. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 5]
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190 -- N. C
IBTTX-.ILjIE'X.insr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, X. C.
i
Geo. G. Thomas, M. D., Pres., Wilmington. C. J. O'Hagax, M. D Greenville.
S. Westray Battle, M. D...Asheville. j J. L. Nicholson, M. D Richlands.
Henry W. Lewis, M. D Jackson. Albert Anderson, M. D "Wilson.
Henry H. Dodson, M. D Milton. A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. AUGUST, 1900. No. 5.
Stamina.
WITH SPECIAL REFERENCE TO THE CONSUMP-TION
OF FAT FOOD FOR ITS MAINTENANCE
AND AS A PREVENTIVE OF TUBERCULOSIS.
By A. N. BfiLL, A. M., M. D.
While every observer recognizes the
progress that has been made during recent
years in the prevention of, and the reduc
tion of mortality from, tuberculosis, by
dealing with unsanitary surroundings,
the establishment of sanitaria, changes
of climate, etc., it seems to me that no
one who even approximately compre-hends
the universality of microbic life
—
and of none more than tubercle bacilli
can fail to perceive that, however much
we may be able to modify the external
relations bearing upon liability to tuber-culosis,
nevertheless every individual, no
matter where his dwelling-place, is more
or less subject to tubercle bacilli; for, be-sides
the utmost restriction of their preva-lence
by human effort, unless the indi-vidual
is possessed of an organism suffi-ciently
fortified to resist and overcome
conflict with them—for the conflict is
certain everywhere—he is liable to con-tract
tuberculosis. Indeed, every predis-posing
cause of disease is a challenge to
one's power of resistance. Every intelli-gent
person knows that the power of
resisting the ordinary exciting causes of
illness, such as sudden changes of tem-perature,
exposure to damp soil, room or
sheets, or night air with the windows
closed, depends upon one's state of health.
The power of resisting microbes as an
exciting cause of disease is no exception
Health fortified by such conditions as
the organism depends upon for its fabri-cation
and maintenance opposes itself to
all exciting causes of disease by the rela-tive
integrity, strength and vigor of all
the organs and functions of the body. A
person thus equipped, if beset by tubercle
bacilli or other m'crobes, effectually re-sists
them, devours them by oxidation
and casts them off.
Feebleness, on the contrary, though not
always appreciated and sometimes culti-vated,
indeed, by the practice of that
54 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
altogether too popular fad, abstemious-ness,
is always and everywhere a prevail-ing
"predisposition" to disease; and
associated as it commonly is with inade-quate
nourishment, it is the most frequent
of all incitants to tuberculosis. Abstemi-ousness,
however, is variable in its prac-tice,
and uncertain; one may overeat and
yet abstain from some essential food
necessary for the maintenance of health.
Adequate nourishment and stamina de-pend
upon the supply of nutriment in the
kinds and proportions required by our
bodies.
By a somewhat extended observation
and careful study of the relation of tuber-culosis
to food, I have come to the con-clusion,
which it is the purpose of this
essay to vindicate, that, other conditions
being equal, tubercular diseases are preva-lent
in the inverse ratio to the use of fat
of some kind as an article of diet.
Antecedently, in persons on the verge
of pulmonary consumption, inability to
digest fat food is one of the most promi-nent
symptoms. They are afflicted with
dyspepsia, of the kind in which an acid
stomach is predominant—that kind of
dyspepsia which is the common effect of
the excessive and too exclusive use of
farinaceous food, insomuch as, in some
cases, to have created a loathing of fat
food in every form. Nevertheless, in
medical practice generally, this condition
is an indication for the use of fat food.
Cod-liver oil, emulsified or otherwise, is
almost universally the first remedy re-sorted
to and the most persistently urged.
Butter or bacon, the most digestible of all
fat foods, I have often found to be more
acceptable. Fat is the needful thing to
energize both digestion and nutrition.
And that form of it which is the most
acceptable is the best.
In this relation I am reminded of a
conversation on the subject with an old
naval colleague, the late Dr. Richard
McSherry, of Baltimore, some thirty odd
years ago. He related a case then but
recently under his care, in substance as
follows:
A much emaciated German shoe-maker
with pronounced phthisis and a particu-larly
rebellious stomach, had been an
office patient for several months. He
had tried various ways to render cod-liver
oil acceptable, but with discouraging re-sults.
The patient was evidently losing
ground and the intervals between his
calls increased until they had ceased alto-gether;
his condition was such, at his last
call, as to leave but one inference. About
two years had elapsed, when, on respond-ing
to an e

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library of
(El}e University of XTortl] Carolina
COLLECTION OF
NORTH CAROLINIANA
ENDOWED B Y
JOHN SPRUNT HILL
of the class of 1889
. IS
This book must not
be taken from the
Library building.
$&
•&& r^
&x* \f\VfQ\
Form No. 471
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, X. C.
Geo. G. Thomas, M.D., Pres.,Wilmington. C. J. O'Hagan, M. D Greenville.
S. AVesteay Battle, M. D...Asheville. J. L. Nicholson, M. D Riehlands.
Henry W. Lewis, M. D Jackson. Albeet Anderson, M. D- Wilson.
Henry H. Dodson, M. D Milton. A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. APRIL, 1900. No. 1.
Election of County Superintendents
of Health.
We beg leave to call the attention of
all Boards of County Commissioners to
the fact that they are required by the law
as amended by the General Assembly of
1897 to elect a County Superintendent of
Health at their meeting in May. The
Amended law reads: "From this number
(all registered physicians resident in the
county) one physician shall be chosen by
the Board ofCommissioners ofeach county
annually on the first Monday in May of
each year to serve with the title of
Superintendent of Health." We trust
that this important matter will not be
overlooked.
Politics ami Small-Pox.
The inauguration of the political cam-paign
brings to our mind the dangers in
tho matter of small-pox incident thereto,
and we feel that a word of warning would
not be out of place. Unusual interest in
the issues involved seems to be felt, and
the indications are that the meetings will
be very numerous and very largely at-tended,
and of course by all sorts and con-ditions
of men, as they should be in a
democracy.
In the past six months small-pox has
prevailed in nearly half the counties of
the State. The monthly reports for
March show 437 cases for the month in
28 counties, and "a number of cases" in
another county (for details see Review of
Diseases on a subsequent page). Gener-ally
the disease is very mild in character.
Not infrequently it is so mild that tin-patient
does not feel sick enough to go to
bed, but being a little "under the weath-er"
with what he calls, with the indora -
ment of some complaisant or ignorant
physician, "chicken-pox," he is exactly
in the right condition for visiting around
among the neighbors, or loafing at the
railway station, or above all, attending a
gathering of any kind—political pre-ferred.
In many cases the eruption is so
BULLETIN OP THE NORTH CAROLINA BOARD OP HEALTH.
insignificant as not to attract attention, but
nevertheless it is the genuine article, and
capable of causing in theunvaccinated the
most virulent and fatal form of the disease.
Again, small-pox may be spread by in-fected
clothes. Too often it happens that
the disinfection after recovery is not as
thorough as it ought to be, and the poison
that has attached itself to the clothing
(fomites) remains active. It is hardly
worth while to say that an unvaccinated
man wedged in behind such a coat and
breathing the exhalations from it would
catch small-pox almost to a certainty.
The idea of the possibility of a deliber-ate
and malicious spreading of the disease
by some bitter partisan entered our mind
but was immediately dismissed as absurd.
We read, however, in this very morning's
paper a statement of a case exactly in
point, where a man had had "three buggy
whips worn out on him" because he re-fused
to be vaccinated, and threatened if
possible to catch small-pox and spread it
among his political enemies. But be that
as it may, there is no question of the dan-ger
attached to large gatherings of any
kind in communities where small-pox
—
and especially small-pox of exceptionally
mild type, that is too often falsely called
chicken-pox—is prevalent or has recently
prevailed. Indeed, there is danger now
in all large gatherings anywhere in this
section, for small-pox '
' bobs up serenely '
'
in a most unexpected manner in all sorts
of places. We are fairly well supplied
with points of infection ourselves, but our
sister States continue to re-inforce us in
a most unpleasant and undesirable way,
and one never knows when he may come
in contact with it.
The conclusion of the whole matter is
this : Be Vaccinated. That is the sim-plest,
most certain and practically only
solution of the difficulty.
The Animal Meeting of the Board.
According to the law creating the State
Board of Health the annual meeting
must be held at the same time and place
as that of the State Medical Society. The
latter will assemble at Tarboro on Tues-day,
May 22d, and the Board will meet on
the evening of the same day. The next
day, Wednesday, at 12 St., will occur the
usual conjoint session of the Board with
the Society, when we all take counsel to-gether.
It is extremely desirable that as
many county superintendents and munici-pal
health officers should attend this
meeting as possible. We feel justified in
promising all who come both a pleasant
and profitable time.
The Slaughter of the Innocents.
After a very unusual delay spring has
at last arrived. The vegetable world is
springing into renewed life and growth.
Bacteria belong to the vegetable king-dom
and their growth is promoted by
the same conditions that influence plants
visible to the naked eye. The infection
of milk by certain bacteria and the tox-ines
produced therein by their rapid
development in a temperature above 60°
is the chief cause of cholera infantum
and the infantile diarrhoeas, which are
responsible for such a large per cent, of
the mortality of the summer season. The
fact that ninety-seven per cent, of the
deaths from these causes occur in bottle-fed
babies is significant. A large propor-tion
of these deaths could be prevented
by a little care. Of course the hygiene
of the dairy is important, but this is
beyond the control of the consumer in
most instances. The question therefore
is largely limited to the treatment of the
milk after it has come into her possess-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
ion. It is practically impossible to pre-vent
the infection of the milk, so that the
object to be sought is to destroy, or at
least inhibit, the growth of the bacteria
before they can develop the poison.
This can be accomplished by attention to
three things: pasteurization of the milk
as soon after delivery as possible, keep.
ing it cool after this has been done and
perfect cleanliness of all vessels contain-ing
the milk, the nursing-bottle and nip-ple
in particular.
Pasteurization is a big word, but it is
not a very big thing outside of its bene-ficent
results. There are special appara-tus
for the purpose which can be bought
at a low price, but in the absence of such
it can be practically done in this way:
Get a sufficient number of eight-ounce
bottles from the drug store. After the
first time wash them as clean as possible
and then boil them every morning while
breakfast is cooking. Fill the requisite
number with the milk. Stop their
mouths lightly with raw cotton—germs
cannot pass through raw cotton, it is an
effective strainer for them. Place the
bottles of milk in a tin bucket filled with
water up to their necks, together with a
thermometer. Set the bucket on the stove
and let it remain there until the tempera-ture
reaches 155° or 160°. Then remove
the bucket and wrap it in a blanket or some
other woolen material, leaving it near the
stove in order to keep the temperature as
near that point as possible for a half hour.
At the end of that time take out the bot-tles
and put them in the refrigerator or
the coolest place available. Give the
baby a fresh bottle every time he is fed.
After the cotton stopper is removed the
milk will be re-infected. If possible, all
bottles should be nursing-bottles of such
a character as to permit the fitting on of
the nipple. This would avoid trouble
and the danger from possible carelessness
in thoroughly cleansing the nursing-bottle
if only one is used. The nipple should
be washed clean each time, and kept in
a solution of boracic acid of the strength
of one ounce to a quart of water. The
nursing-bottle should be boiled at least
once every day.
If these directions can be brought to
the attention of mothers so unfortunate as
to be unable to nurse their children, and
they can be induced to conscientiously
carry them out, many a little life will be
saved, and many a mother's heart spared
the keenest anguish.
Leprosy.
The General Government through the
Marine Hospital Service and the Ameri-can
Medical Association through a special
committee are engaged in an investiga-tion
of leprosy in the United States. Ap-peals
for information as to the existence
of the disease in this State have come to
us from both sources. We have replied,
with much satisfaction, that so far as we
were informed there was not a single case
of leprosy in North Carolina. But it may
be that we are not sufficiently informed.
Our sj'stem of health reports outside of
the cities and larger towns is very im-perfect.
It seems to be impossible to get
physicians generally to report at all to their
county superintendents of health. "We
therefore avail ourself of the fact that the
Bulletin is sent to every physician in the
State to ask each one who reads this if he
knows of a case of leprosy to report it to
this office promptly.
A Serious Kiidemie of 1'iieumoiiia in
Carteret County.
( )n the 20th inst. we received a letter
from a physician in the eastern part of the
State saying that a man from Atlantic in
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Carteret county told him that a fatal dis-ease
affecting the "throat" and accom-panied
hy "swelling of the tongue" was
prevailing in his neighborhood, that it
was extremely fatal, and that the people
were almost panic-stricken. He added
that he would call our attention to it and
ask that it be investigated. Dr. Clarke,
the Superintendent of Health of Carteret,
mentioned in his report for February the
occurrence of a very fatal outbreak of
pneumonia in one locality in the county,
but reported nothing special for March.
We immediately wrote Dr. Clarke the
facts as stated to us, and we append his
tragically interesting reply :
Beaupokt, N. C, April 23, 1900.
R. H. Lewis, M. D.,
Rah igh, X. C.
Dear Sir:—Replying to your letter of
April 20th ult., I have to inform you
that the disease of which you inquire is,
or rather was, for no new cases have been
reported since two weeks ago, pneumonia.
I referred in one of my last two reports
to the fact that numerous deaths had oc-curred
in one or two localities along Core
Sound, "presumably from pneumonia."
Since my last report I have made two visits
to Atlantic. Every case seen (five) was un-mistakably
acute lobar pneumonia, and
all young men.
Between twenty and twenty-five deaths
have occurred at Atlantic—all men, so far
as I learned. No children nor women
were affected, and no two cases, so far as
learned, occurred in one house.
Pneumonia (presumably) first appeared
in a locality about twenty miles from At-lantic
earlier in the season, and numerous
deaths occurred. Several intervening com-munties
have been unaffected (uninfected).
Atlantic is a thickly settled community
of several hundred people, really a town.
The fact that practically men only have
suffered is accounted for by the fact that
after infection they have been exposed
to the weather, frequently wet by rain or
salt water (they all live by fishing, crab-bing
or catching oysters).
The women and children are even
more exposed to the primary infection,
being more closely confined to the house,
but lack the secondary or inciting cause,
and in their cases pneumonia has not
been developed.
I may say that at a first visit I invari-ably
found a house packed with people,
so that infection was general after one or
two cases had occurred. I of course gave
them different instructions, both on their
own and the patients' account, and advised
them to avoid exposure and getting
chilled until mild weather appeared.
No new cases have occurred since my
last visit. I saw some men from Atlan-tic
this morning who left home yesterday
(Sunday) and questioned them.
Yours truly,
F. M. Clarke.
Small-pox in Mississippi.
The small-pox has existed in mild form
in Mississippi for three years. In Febru-ary
in Hinds county it suddenly assumed
a virulent and loathsome form, and dur-ing
the past six weeks there has been
over 100 deaths. On some days the death
rate has been so large that it was impos-sible
to secure coffins. Whole families
have been wiped out of existence, and of
several large families only one or two
children are left. The absence of deaths
in the beginning, the disagreement con-cerning
diagnosis among the physicians,
the apathy of the business men and the
general failure to support preventive
measures, all contributed their part to
this finale. It is good business to put
out even little fires, and it is equally good
business to put out even little epidemics. —Bulletin of Indiana Board of Health.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Review of Diseases for March, 1900.
EIGHTY-FIVE COUNTIES REPORTING.
Ninety-three counties have Superinten-dents
of Health.
Except in the case of the more contagious
and dangerous diseases, the Superintendent
has, as a rule, to rely upon his own infor-mation
alone, since few physicians can be
induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise in-dicated,
its mere presence in the county is
to be understood as reported.
For the month of March the following
diseases have been reported from the
counties named
Measles.—Alamance, 200 ; Alleghany,
general; Ashe, 60; Beaufort, several; Ber-tie,
several ; Caswell, several ; Chatham,
many ; Cherokee, many ; Clay, 2 ; Cleve-land,
a few ; Columbus ; Craven, 20
;
Duplin, many ; Graham, several ; Gran-ville;
Greene, 300; Guilford; Halifax,
general; Harnett, 50 to 100 ; Hertford, 4;
Iredell, 5 ; Johnston, general ; Jones,
several ; Martin, 50 ; Montgomery, 6
Moore, 5; Nash, epidemic; New Hanover,
8; Orange; Pasquotank, 2; Person, 7; Pitt,
general ; Rutherford, a few ; Sampson, a
few; Swain, 1 ; Vance, several; Wake, 6,
many others in one section; Watauga,
general ; Wayne, 30 ; Wilkes, in many
parts; Wilson, general; Yadkin, 4—42
counties.
Whooping-cough.—Beaufort, several
;
Caldwell, 10 ; Cleveland, many ; Colum-bus
; Craven, 8 ; Currituck, 2 ; Duplin, a
few; Durham, a few; Graham, several;
Granville; Greene, 200; Halifax, general;
Harnett, a few; Henderson, many; Ire-dell,
4; Johnston, general; Macon, several;
Martin, 50 ; Mecklenburg ; Montgomery,
10; Nash, epidemic; Orange; Pitt, general;
Richmond, general ; Robeson ; Stanly,
several; Swain, 2; Transylvania, 10; Wake,
3; Watauga, general—30 counties.
Scarlet Fever.—New Hanover, 1; Pas-quotank,
1; Vance, 1.
Diphtheria.—Mecklenburg, 1 ; Mont-gomery,
2; New Hanover, 1; Wake, 1.
Typhoid Fever.—Alamance, 3 ; Ashe,
6; Beaufort, a few; Cabarrus, 4; Chatham,
a few ; Columbus, 1 ; Dare, 2 ; Harnett, a
few ; Hertford, 1 ; Madison, 2 ; Mecklen-burg
; Montgomery, 4 ; New Hanover, 2 ;
Robeson; Stanly, several; Union, 4; Vance,
1; Wake, 2; Warren—19 counties.
Malarial Fever.—Beaufort ; Craven ;
Hyde ; Johnston ; Person ; Wake.
Malarial Fever, Hemorrhagic —
Craven, 1 ; Hyde, 2 ; Person, 1 ; Wake, 1.
Influenza.—Alleghany, Beaufort, Ber-tie,
Caldwell, Carteret, Caswell, Catawba,
Chowan, general ; Cleveland ; Craven ;
Currituck ; Duplin ; Forsyth, Graham,
Guilford, Halifax, general; Hertford;
Iredell, general ; Johnston ; McDowell
;
Macon, Martin, Mitchell, Moore, New
Hanover, general; Northampton; Onslow,
Pender, general; Person; Richmond, gen-eral;
Robeson; Sampson, in many parts;
Stokes, general ; Surry ; Swain ; Union ;
Wake ; Washington, Wilkes, general
—
39 counties.
Pneumonia. —Alleghany ; Buncombe ;
Carteret; Catawba; Chowan, in all parts;
Dare, 2 ; Forsyth, in all parts ; Franklin ;
Gaston, common ; Gates, in grave form,
with many deaths; Granville, in all parts;
Hyde ; Martin, more than ever before
;
Northampton, in some parts; Onslow;
Pasquotank ; Person ; Sampson, in many
parts ; Swain ; Union ; Wake ; Washing-ton,
in all parts; Yadkin—23 counties.
Mumps.—Caswell, in nearly all parts ;
Cumberland, in all parts; Halifax, in all
parts; Pitt, in all parts; Washington, 1 ;
Watauga, in all parts—') counties.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Eoseola.—Caswell, Gaston, general.
Vaeicella. — Cumberland, Halifax,
general.
Small-pox.—Alamance, 20; Alexander,
3; Buncombe, 15, under control; Burke,
1; Cabarrus, 1; Caswell, 1; Chowan, 6;
Davidson, 3; Davie, 8, one death; Dur-ham,
3 ; Gates, 2 ; Guilford, 61 ; Harnett,
5; Henderson, 1, stamped out ; Hertford,
3; Iredell, 1 ; Johnston, 1 ; Mecklenburg,
18, in the western part chiefly ; Moore,
67 ; Nash, 10 ; New Hanover, 2 ; Orange,
20; Person, 17; Randolph, 1, confluent;
Robeson, 27; Rockingham, 120, six
deaths; Rutherford, a number of mild
cases; Stanly, 1, following 20 in February
no spread after quarantine and vaccina-tion;
Warren, 1—29 counties.
Cholera in Fowls.—Hyde.
Cholera in Hogs.—Bladen; Columbus,
less than in former years ; Hyde ; Moore.
Hydrophobia in Dogs.—Ashe; Caswell.
Pink Eye in Horses.—Cherokee.
No diseases are reported from Bladen,
Edgecombe, Haywood and Polk.
No reports received from Anson, Bruns-wick,
Jackson, Lenoir, Lincoln, Per-quimans,
Rowan and Yancey.
Summary of Mortuary Reports for
March, 1900.
(twenty towns).
Only those towns from wThich certified
reports are received are included.
White. Col'd. Total.
Aggregate popula-tion
68,875 50,075 118,950
Aggregate deaths... 91 74 165
Representing tem-porary
annual
death rate per
1,000 15.9 17.7 16.6
Causes of Death
Typhoid fever 12 3
Malarial fever 112 Measles.: 11 Pneumonia 24 14 38
Consumption 12 10 22
Brain diseases 5 16 Heart diseases 6 6 12
All other diseases.. 40 37 77
Accident 2 2 4
91 74 165
Deaths under five
years 17 17 34
Still-born - 4 8 12
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for March, 1900.
Towns
and reporters.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. E. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. D. B. McNeill.
Buncombe Dr. E. E. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. F. Houck.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham ...Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Floskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J.Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bvnum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. H. Cannady.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. W. L. Crouse.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. George F. Lucas.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. W. C. Bostic.
Randolph Dr. T. T. Ferree.
Richmond Dr.v
J. M. Covington.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford '..Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland
Stanly Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. P. E. Hines.
Warren Dr. T. B. Williams.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. W. J. Jones.
Wilkes Dr J. W. White.
Wilson Dr. W. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancev Dr. W. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 9
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each mouth, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
.189-— N. C.
B"criL.i-.E]Ti3^r
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Riehlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. MAY, 1900. No. 2.
Drinking Water.
It is with genuine satisfaction that we
lay before our readers the truly excellent
paper on the above subject, read at our
last Health Conference by Dr. Pate. It
is directly to the point and presents the
subject of drinking water in its relation
to disease in a clear, forcible and practi-cal
manner. The same thing has been
done time and again by writers on sani-tation,
but we do not remember to have
ever seen it better done in the same space,
if at all.
We desire to commend especially to
the thoughtful and conscientious consid-eration
of our medical readers what Dr.
Pate says in regard to the responsibility
of the family physician in this connec-tion.
As we have repeatedly said in
these columns, no board of health, no
matter how complete in organization,
equipment and endowment, can do thor-ough
work without the action and hearty
co-operation of the medical profession.
The disastrous consequences of the indif-ference
or opposition of an occasional in-dividual
member of the profession is at-tested
by more than one widespread
epidemic of smallpox in our State in the
recent past. The family physician should
be the sanitary as well as medical adviser
of those who intrust themselves to his
care. No one can be such an effective
health officer as he directly, as he is
the maker of public opinion on medical
and sanitary lines, and the failure of the
best directed efforts to protect the health
of the people is too often due to his indif-ference
and failure to say a few words in
season. This very thing has discouraged
us more than all else, but there has been,
we are gratified to sa"y, a marked im-provement
of late in this respect. May
it increase:
DRINKING WATER.
Read at the Wilson Health Conference.
BY DR. W. T. PATE, OF GIBSON, N. C.
It has been my observation that there
is no surer way to displease ;> friend, or
block the avenues to friendly relations
with a stranger, than to condemn his
drinking water. Associations have in-vested
our water supplies with a aenti
12 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
ment next to home itself. It seems hard
to realize that the spigots that have ad-ministered
to our wants and necessities
in days of health and pleasure could in
an evil hour dispense sickness and be-reavement;
or that the well that had fur-nished
water to raise a family could also
exterminate it. It is not my purpose to
rob this necessary element to our exist-ence
of any of its sentiment, but to try to
make it more deserving by calling atten-tion
to the fact that the good and bad are
so thoroughly mixed in all things that it
even applies to water supplies.
All drinking water, unless it be that
from deep artesian wells, contains bacte-ria,
or unicellular vegetable organisms,
which are like vegetables of a higher
type, in that some kinds are harmless
—
even wholesome,—while other kinds are
poisonous. We speak of water as being
contaminated when it contains some of
these poisonous organisms. The chief
source of the bacteria found in drinking
water is from the soil. For our purpose
we will speak of the modes of contamina-tion
as direct and indirect. Direct when
the dangerous bacteria are introduced
into the water from first hands. Indirect
when the bacteria are deposited upon the
earth and then carried into the drinking
water by the rain that falls upon the sur-face
or the water that percolates through
the soil.
About 7 per cent, of the population of
North Carolina obtain their drinking
water from public supplies, the source of
nearly all of which is surface-water ex-posed
to both direct and indirect contam-ination.
But these supplies are better
than private wells in city soil. They are
easier to protect, and are capable of such
intelligent management as will place them
within the bounds of safety. But this
will hardly be accomplished before an
educated public sentiment demands it.
When the consumers of public water
fully realize that pure water and a good
health record go hand in hand to attract
desirable home-seekers and capital; when
they thoroughly appreciate the fact that
their own prosperity, happiness, health
and lives may depend upon the purity of
their drinking water; when they feel
that the suffering and death from typhoid
fever in the community are due to
some one's carelessness and might be pre-vented—
then they may be depended
upon to see that every precaution known
to sanitary science is thrown about the
public water supply.
The men occupying the best position
to teach these truths of sanitation and
create this public sentiment are the phy-sicians
of the town. Any town having a
public water supply that is causing an
unusual number of cases of typhoid fever
and other water-borne diseases is a re-proach
to the physicians of the commun-ity.
Every man of means and influence
has a family physician, and if that guar-dian
of the health of the home will take
the pains to impress upon his patron the
importance of pure drinking water, he
will not only demand it, but will support
any reasonable measure to improve and
protect the public supply. I say this
with all due respect to our efficient State
Board of Health. Its work is gaining in
appreciation among the people, and is
attracting attention beyond our own bor-ders.
I have heard its work commended
from the State of Maine. But the Board
can at best only direct, map out the
work and suggest plans. If the highest
practical good is to be accomplished for
the community and the State, the Board
must have the hearty, active co-operation
of her intelligent citizens, and especially
that of the medical profession.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 13
The remaining 93 per cent, of our pop-ulation
represent the inhabitants of the
smaller towns and the country, who are
less fortunate than their city cousins, in
that each home has its own supply, and
must bear the expense and exercise the
necessary care to keep their drinking
water in a safe condition or suffer the
consequences. The chief burden of these
supplies is sustained in complying with
the last named condition. These sup-plies
consist principally of dug or open
wells and driven wells. The latter are
safer, since they are exposed only to
indirect contamination. Open wells from
which the water is brought to the sur-face
in buckets, are filthy and dan-gerous.
Any one who has seen one of
these wells cleaned out knows what
a quantity of filth finds its way into
the water from the open top. Every one
that draws a bucket of water handles the
wet bucket and chain and sends it down
to be washed off by the water in the
well, which amounts to about the same
thing as washing the hands in the drink-ing
water, not to speak of contamination
by mosquitoes and other insects. Such
wells undoubtedly cause many cases of
gastro-intestinal troubles, not usually fa-tal,
except among small children. And, if
typhoid fever is carried to a home using
an open well, it takes intelligent manage-ment
to prevent the drinking water from
becoming contaminated, and servants do
not always possess the necessary intelli-gence,
as was shown in a case that came
under my observation at a farm-house
two miles east of Gibson.
This well had been in use more than
five years. It was the boast of the owner
that he had the best water in his section,
and that there had never been a case of
typhoid fever on his plantation. During
the winter of 1895 a son was carried to
this home with a well developed case of
typhoid fever. A nurse was employed at
once, the patient isolated, and the physi-cians
in attendance thought every pre-caution
had been taken to protect the
other members of the household; but in
about three weeks two other members of
the family were sick with the fever. The
physicians were puzzled until it was
learned that the launderer had remarked
that the ' doctors might know something
about medicine, but that they didn't
know anything about washing; and in-stead
of carrying the linen, bundled by
the nurse, from the sick-room to the ket-tle
and boiling for a half hour before
washing, as directed by the physicians,
he had first washed the clothing in warm
suds, drawing his own rinsing water at
the open well. This act of carelessness
and ignorance cost the life of one mem-ber
of the family.
Another case showing the extreme lia-bility
of open wells to typhoid contami-nation
occurred just across the line from
Gibson in South Carolina. Another
plantation home—an open well with
sweep, hand-pole and bucket—a bench
adorned by a row of tubs—a wash-pot,
and a mud-hole with a few brickbats in
it—all within a radius of 15 feet—the
counterpart of many domestic water sup-plies
in North Carolina to-day.
There had been no case of typhoid
fever here. During the winter of 1884 a
married daughter died of typhoid fever
in another county. Her sick child was
carried by its grandmother to this home,
some 15 miles away. The child died;
members of the household and neighbors
and friends who visited them in due time
began to have fever; an epidemic broke
out in the community; and if it were
possible for any one to state the number
of cases that were carried directlv and in-
14 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
directly from that well, the cost of life
and property to the community, it would
seem incredible. I know that some fami-lies
were so reduced by sickness, death
and debt that their homes went into
other hands.
Where it is practicable only driven
wells should be used to obtain water for
domestic purposes. Where it is necessary
to dig wells, after an unfailing flow of
water is secured, terra-cotta well-pipe
should be placed in the well and the well
filled in, the top closed and the water
raised by suction. Where the terra cotta
pipe is too costly a two inch iron pipe can
be carried to the bottom of the well, this
filled around with stones above the level
of the water, three feet of chalk and clay
packed in above the stones and the well
filled with clean earth. This will prevent
direct contamination, and lessen the at-traction
for surface-water. Indirect con-tamination
can be prevented by a clean
soil. A circle with a radius of 100 feet
should be drawn around the well and the
perimeter designated the danger line, and
nothing that would pollute the soil should
be allowed within this circle—not even
an open well. I have seen driven wells
placed within a few feet of an open well
to improve the water supply. It is need-less
to say that there was no improve-ment.
All waste-water from the well,
wash-basins, etc., should be conveyed be-yond
the clanger line in water-tight pipes.
Another important matter is surface
drainage. The stables, pig-styes, etc.,
should be so placed on the premises that
the surface—drainage will be away from
the well. One hundred feet, nor any
other reasonable distance, will not pro-tect
a well on a slope below polluted soil.
I have seen a driven well 28 feet deep on a
slope 300 feet away from a basin polluted
for a generation, contain intestinal bacilli
from the first. Another instance is that
of a factory village built on an eastern
slope. Near the brow of the hill is a row
of out-houses. One hundred feet or more
down the grade is a broad street, a row
of houses on either side of the street, and
driven wells along its centre, more than
100 feet from the out-houses, along the
brow of the hill. For the first few years
the village was not infected with typhoid
fever. In December, 1895, I was asked
by the president of the company to see a
boy in the village that was thought to be
crazy. I found him sitting up, tempera-ture
104, delirious, with other symptoms
of typhoid fever. The attention of the
president of the company was called to
the bad arrangement of the village, and
warned of the danger. A meeting of the
directors was called, but nothing was
done. The number of cases have in-creased
year by year until now. In Sep-tember
I was informed by one of the
three physicians who practice among the
operatives that he then had thirty cases
of typhoid fever under treatment in the
village, and that the death rate was high.
This is due to the surface-water from the
row of out-houses along the brow of the
hill running down the slope and infect-ing
the wells.
In conclusion, I would say: Use only
underground wells; raise the water by
suction; see that the soil is free from pol-lution
within 100 feet radius of the well,
and drain all polluted soil on the prem-ises
away from the well. By a strict ob-servance
of these simple precautions it is
possible, in a primitive soil, to obtain
water with less than 100 harmless bac-teria
per cubic centimeter.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 15
••Death in the Pot."
Such was the title of a treatise pub-lished
in England in 1820, calling atten-tion
to the adulteration of food and its
often injurious effects upon the system.
Owing to chemical discoveries the facili-ties
for adulterating food within the past
few years have been much greater than
ever before, from the fact that almost
every variety of food is now put up in
enormous quantities in cans, and spices
of every kind pulverized and sold to the
public in small packages, so that their
purity can only be detected by careful
analysis. Some of these adulterations
are comparatively harmless, simply de-creasing
the strength and value of the
product, but others, which are more
commonly used in the finer quality of
goods, disguise their real condition, and
by their drug action disturb the digestion
and poison the blood.
An article in the Lancet, of April 22,
speaks of meat extracts of "vile origin,"
showing they are sometimes made of
putrid liver and offal, and that such
filthy material is fabricated into a tooth-some
paste, the use of deodorizers and
subtle flavoring material having been
placed at the disposal of offal-mongers by
the advance of chemical knowledge. Of
course cooking would destroy most nox-ious
germs, but their products, the pois-onous
ptomains, would remain and their
presence in an extract would cause very
serious symptoms of poisoning. The pro-ceedings
of the War Investigating Com-mittee
called the nation's attention to the
action of adulterated food, and if it was
productive of no other benefit, it led to
official reports in several States of the
alarming extent to which the adultera-tion
had been carried with well-localized
f poisonous results.
Mr. "Wells, the Pennsylvania Food and
Dairy Commissioner, states that chemi-cal
companies have agents traveling ail
over the State selling to butchers chemi-cals
for preserving meat. The packages
are labeled, telling how they are to be
used. And some of them are used wher.
the putrefaction has already commenced.
In the last annual report of the Connec-ticut
Experimental Station it is stated
that of sixty-three samples of jellies, two-thirds
were adulterated, not only with
starch and glucose, but with aniline dye
and salicylic acid. Out of forty samples
of marmalades and jams only three were
pure. Of forty-seven samples of beer
and ale, twelve contained salicylic acid,
and nineteen samples of sausages and
oysters were found embalmed by boric
acid. Salicylic acid as a food preserva-tive
has been forbidden by several Euro-pean
governments. Here it is largely
used by canners and butchers. The De-partment
of Agriculture found it in fif-teen
out of twenty samples of string
beans, in ten out of twelve samples of
baked beans, and in twenty out of forty-one
cases of corn. Is it any wonder, in
face of this adulteration of so many of
the common articles of daily food, that
so much dyspepsia and general derange-ment
of the system, produced by it, ex-ists
to so large an extent in our populous
towns and cities? Salicylic acid, the
favorite preservative used, has been pro-nounced
by the Paris Academy of Medi-cine
not only provocative of, but espe-cially
injurious to, dyspeptics. The bodily
sufferings of hosts of individuals, for
which no adequate cause is assigned, are
undoubtedly due in many, very many,
cases, to the systematic food poisonii g
for the profit of dishonest dealers. The
coal-tar products are used to a large ex-tent
in cheap confectionery and in the
16 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
flavoring extracts of the kitchen. In a
Western hotel nearly all the guests be-came
sick, and the cause was traced to
the cheap coal-tar extracts used in the
kitchen. To remedy this wholesale pois-oning
from adulterated food it has been
suggested that a national food commis-sion
be organized with the power of ex-amining
manufactured products and
testifying as to their quality, these pro-ducts
of food and drink to have on printed
labels the contents of the packages.
Every physician, if properly trained in
laboratoiy work, would be entirely com-petent
to determine the condition of
every product of food or drink, as it re-gards
adulteration, submitted to him.
But to accomplish this, more efficient in-struction
should be given in chemical
analysis in our medical colleges, and
questions introduced into the State medi-cal
examinations fully testing the knowl-edge
of students in the action of drugs
used in all adulterations connected with
food and drink, and their ability to de-tect
these poisons by the necessary un-failing
scientific tests. The examination
by the State Board of Examiners in this
department of medical studies should be
so minute and so exhaustive as to leave
no doubt that the student was thoroughly
competent for all the details of the work
as it regards examination, and the medi-cinal
action of the materials used upon
the human system. We respectfully call
attention of the Regents to the impor-tance
of this suggession.—A'. Y. Medical
Tiim 8.
Review of Diseases for April, 1!)00.
EIGHTY-FOUR COUNTIES REPORTING.
Ninety-three counties have Superinten-dents
of Health.
Except in the case of the more contagious
and dangerous diseases, the Superintendent
has, as a rule, to rely upon his own iufor-mation
alone, since few physicians can be
induced to report cases of non-contagious
diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise in-dicated,
its mere presence in the county is
to be understood as reported.
For the month of April the following
diseases have been reported from the
counties named
:
Measles.—Ashe, 40; Bertie, many;
Buncombe, 50; Carteret; Caswell, several;
Chatham, many; Cherokee, many; Cleve-land,
a few; Columbus; Craven, S; Cum-berland,
in all parts; Davidson; Graham,
25; Granville; Greene, 800; Halifax, in
many parts; Harnett, 300; Hertford, 2;
Martin, 200; Nash, epidemic; New Han-over,
55; Northampton; Pasquotank, 2;
Perquimans, ti; Person; Pitt in all parts;
Richmond, general; Robeson, epidemic;
Rockingham; Rutherford, many; Samp-son,
a few; Surry, 6; Wake, 8; Warren,
some: Washington, 20; Watauga, general;
Wayne, 25; Wilkes, 1; Yadkin, in all
parts— 39 ceunties.
Whooping-cough. —Beaufort, several;
Bertie, many; Buncombes many; Bladen,
a few; Caldwell, 10: Cleveland, a few; Col-umbus,
general; Craven, 6; Gates, many;
Graham, 20; Greene, 500; Halifax, in
many parts; Iredell, many; Macon; Madi"
son, 40; Martin, 50; Mecklenburg; Nash;
New Hanover, '.»; Person; Stanly, several;
Warren, a few; Watauga, general — 23
counties.
Scarlet Fever. — Mecklenburg, 3;
Rockingham, 1; Vance, 1.
Diphtheria.—Craven, 2; Mecklenburg,
1; Surry, 1.
Typhoid Fever.—Alamance, 3; Ashe,
2; Cabarrus, <>; Chatham, a few; Colum-bus,
2; Craven, 2; Durham, 1; Greene, 1;
* Haywood, 3; Nash, 2; Perquimans, 2;
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 17
Rockingham; Stanly, 4; Union, 3; Vance,
1 ; Warren, a few—16 counties.
Malarial Fever.—Hyde.
Malarial Fever, Hemorrhagic.—
Hyde, 1.
Malarial Fever, Pernicious—Hyde, 2.
Influenza.—Alamance; Ashe, general;
Bertie, in many parts; Buncombe; Cald-well,
in most parts; Carteret; Catawba,
general; Chatham, general; Chowan, gen-eral;
Clay, influenza; Columbus; Curri-tuck;
Davidson; Franklin; Gaston; Gates,
general; Graham, general; Greene, gen-eral;
Harnett, general; Henderson, gen-eral;
Hertford; Hyde, general; Iredell,
general; Lenoir, general; Lincoln, gen-eral;
McDowell; Macon, general; Martin,
general; New Hanover, general; North-ampton;
Orange, general; Pender, in
many; Perquimans, 5; Person; Pitt, gen-eral;
Randolph, much; Richmond, gen-eral;
Robeson; Rutherford; Sampson;
Stanly, general; Swain; Transylvania;
Union; Vance, general; Wake, general;
Watauga; Wayne; Wilkes; Yancey, gen-eral—
51 counties.
Pneumonia. — Ashe, general; Bun-combe,
Carteret: Catawba, general; Cher-okee;
Gaston; Gates, general; Harnett,
general; Jackson; Pender; Pitt, general;
Rutherford; Sampson, general; Wake,
general; Wilkes; Wilson, general; Yad-kin,
general—17 counties.
Mumps.—Beaufort, general; Carteret;
Caswell, in all parts; Davidson; Halifax;
DcDowell; Northampton; Person; Wash-ington,
in all parts—9 counties.
Roseola. —Bladen; Caswell, in all
parts; Union.
Rubella. —Craven, epidemic.
Rotheln.—Mecklenburg; Sampson, in
all parts.
Varicella.—Cumberland, in all parts;
Halifax; Richmond, in all part-.
Small-pox.—Alamance, 18; Alexander,
12; Buncombe, 21; Cabarrus, 4; Caswell,
14; Chatham, 11; Cleveland, 11; Cumber-land,
1; Davidson, 6; Davie, 14; Durham,
]•'.; Forsyth, 1; Gaston, 3; Granville, 1;
Guilford, 32; Harnett, 8; Haywood, 1;
Hertford, 6; Johnston, 32, for February
the number should have been given as
4; Mecklenburg, 18; Nash, 25; Orange, 17;
Pender, 8; Person, 11; Randolph, 6; Robe-son,
6; Rockingham, 291; Stanly, 2;
Wake, 9; Wilkes, 1—30 counties.
Cholera ix Hogs—Columbus, to some
extent.
Distemper in Horses. —Richmond,
Wake.
Hydrophobia in Dogs.—Ashe.
No diseases are reported from Dare,
Edgecombe, Mitchell, Polk and Stokes.
No reports received from Alleghany,
Anson, Brunswick, Cherokee, Duplin,
Jones, Montgomery, Moore and Rowan.
Summary of Mortuary Reports for
April, 1900.
( N I N ETEEN TOWNS)
.
( >nly those towns from which certified
reports are received are included.
White. CoVd. Total.
Aggregate popula-lion
....!. 67,375 49,575 116,950
Aggregate deaths... 92 97 189
Representing tem-porary
annual
death rate per
1,000 16.3 22.S L9.2
Causes of Death.
Typhoid fever 1 °
Scarlet fever
Whooping cough... 1
Pneumonia 15 1 ( >
->l
Consumption 8 ''
Brain diseases 3 •_>
Heart diseases 6 >_
Diarrhceal diseases 4 3 <
All other diseases.. 49 63 H-Accident
4 5
92 97 189
Deaths under five
vears 13 30 43
Still-born - 4 L5 19
18 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for April, 1900.
Towns
and Reporters.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 19
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr.-B. E. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. D. B. McNeill.
Buncombe Dr. E. R. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. R. S. Young.
Caldwell Dr. A. F. Houck.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins. <
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J.Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks. .
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum,
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. H. Cannady.
Greene Dr. Joseph E. Grimsley
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. 0. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. W. L. Crouse.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. George F. Lucas.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. W. C. Bostic.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Covington.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford .'Dr. W. A. Thompson.
Sampson •. Dr. R. E. Lee.
Scotland
Stanly Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. P. E. Hines.
Warren Dr. T. B. Williams.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. W. J. Jones.
Wilkes Dr J. W. White.
Wilson Dr. \Y. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancey Dr. W. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. '21
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever -
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever .-- Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190— V 0.
BTTLiILiIETXlfl"
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. JUNE, 1900. No.
Annual Meeting of the Board of
Health.
The annual meeting of the Board was
held at Tarboro May 22—23, all the mem-bers
being present.
Among other things, resolutions were
adopted requesting the State Board of
Agriculture to slightly amplify their pro-posed
biological laboratory so as to pro-vide
for the bacteriological examination
of drinking waters, when requested by
the Secretary of the Board of Health.
These resolutions were duly presented to
the Board of Agriculture at its recent
meeting, and we are glad to say were re-ceived
with favor, unanimous action be-ing
promptly taken with a view to carry-ing
out our request. Much good will
doubtless be accomplished by this en-lightened
action of the Board of Agricul-ture,
and, for the people of the State, as
well as the Board of Health, we wish to
express our appreciation of if.
The conjoint session with the State
Medical Society was called to order at 12
m. of Wednesday, the 23d, the second
day of the meeting of the Society, accord-ing
to the custom of many years, Dr.
Charles J. O'Hagan presiding, in the
necessary absence of President Thomas
at that time. Dr. O'Hagan on taking the
chair, with the readiness and grace as a
speaker so characteristic of him, deliver-ed
a very interesting address on general
lines, literally on the spur of the moment,
as he was entirely without notice.
The annual report of the Secretary, and
the two small-pox inspectors, Drs. Harrill
and Tayloe, were read.
On motion, the Secretary was thanked
for his labors-, and a copy of his report
ordered printed and distributed to the
physicians and the county commissioners
of the State.
Resolutions in regard to pure food
legislation, the outside insane, and small-pox
were adopted.
The reports and the resolutions were
as follows
ANNUAL REPORT OF THE SECRE-TARY
OF THE NORTH CAROLINA
BOARD OF HEALTH.
The work of the Board, since my last
report, in addition to the regular routine
of the Secretary's office, made up chiefly
24 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
of advice on sanitary subjects to individ-uals,
municipalities, corporations, and
health officers in person, by letter, and by
telegram, and the preparation of matter
for the monthly Bulletin, has consisted
in inspections of some of the State insti-tutions,
the. holding of the annual health
conference with the people, and the
effort to direct, as far as our powers per-mitted,
the management of the epidemic
of small-pox, which I regret to say has
prevailed quite extensively throughout
the State during the past year.
[NSPECTIONS OF STATE INSTITUTIONS.
Inspections by committees from the
Board, appointed by the President, have
been made of the three Hospitals for the
Insane, the University, the Normal and
Industrial College, the two Agricultural
and Mechanical Colleges, the school for
the Deaf and Dumb at Morganton, and,
at the special request of his Excellency,
the Governor, of the abandoned convict
camp at Castle Hayne, with a view to its
healthfulness for that purpose. With the
exception of the State Normal and Indus-trial
College at Greensboro, we found all
the institutions in a good sanitary condi-tion,
although a more abundant water
supply is needed at the University.
Learning that the Board of Trustees of
the Normal and Industrial College would
meet before the report of the regular
Committee of Inspection could reach
them, I felt it my duty to make a per-sonal
visit to that institution and supple-ment
the investigation already made, so
that I might be in a position to advise
directly with the Board. I was invited
to appear before the Board and make to
them a verbal report of my investigations,
and to give them my views as to the sit-uation.
Having done this, I was re-quested
to prepare a full and candid re-port,
suppressing nothing, and give it to
the leading newspapers of the State.
This was promptly done, and sent to all
the morning dailies in the State. It was
also printed in the Bulletin, and as every
physician whose address is known re-ceives
regularly a copy of that publica-tion,
you have already read it, or have
had an opportunity to do so, at any rate,
and it would, therefore, be superfluous to
repeat it here. After this report was
given to the newspapers, I made two
other visits to the Normal and Industrial
College, and learned certain additional
facts which confirmed the view first ex-pressed,
that the cause of the outbreak
of typhoid fever was the water of the
central well which was drunk by all the
students taking their meals in the Col-lege,
to whom the sickness was limited,
and which was found by two bacteriolo-gists,
Drs. Albert Anderson, of Wilson,
and A. C. Abbott, of Philadelphia, to be
infected with intestinal bacilli. These
new facts were set forth in a supplemen-tary
report, which was printed, together
with the original report, in the Bulletin
for December, 1899. The medical report
of the fever by Dr. W. P. Beall, of Greens-boro,
the chief consultant, was given to
the profession through the columns of
the Carolina Medical Journal, and was
reprinted in the Bulletin for February.
In round numbers, one-third of the total
college population had fever, and there
were fourteen deaths. As every county
in the State had a representative in the
student body, and most of them one
among the sick, the deep solicitude and
wide- spread interest felt throughout the
State, not only in that particular out-break,
but iu the subject of typhoid fever
in general, its causation and its prevention,
can be easily understood. Realizing this,
I availed myself of the opportunity to
"point a moral" at the conclusion of the
report referred to in the following words:
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 25
"Every city and town should have an
expert inspector of plumbing, and require
inspection by hitn of every job before it
is covered up and accepted, and all public
institutions and private boarding schools
and other establishments with plumbing
should require a similar inspection. AVells
near sewers, or any accumulation of filth,
especially of human origin, are danger-ous.
Guard with jealous care the purity
of your drinking water."
Whether any of our cities and towns
have acted upon the suggestion as to the
employment of an expert inspector of
plumbing, and the requirement that all
plumbing work should be inspected and
approved by him before being accepted,
I have not been informed, but the sug-gestion
as to drinking water did bear
some fruit. The University and the Ag-ricultural
and Mechanical College for
whiten, of the State schools, and St.
Mary's, at Raleigh, and the Horner Mili-tary
School at Oxford, of the private ed-ucational
institutions, had bacteriological
examinations made of their water sup-plies,
thereby exhibiting a progressive
and enlightened spirit that is worthy of
commendation, and setting an example
that it would be wise for others to follow.
While the outbreak of typhoid fever at
the Normal and Industrial College is
greatly to .be deplored, its educational
effect upon the people has been great, and
the final result in the coming years will
no doubt be the saving of many more
lives than were lost. The history of san-itary
science shows that no material ad-vance
in its practical application has ever
been made, except as a consequence of
some tragedy of this sort.
THE HEALTH CONFERENCE.
In the hope of interesting and instruct-ing
the people of some of our largest cities
and towns in matters pertaining to the
public health, meetings of the Board with
the people for the purpose of discussing
before and with them, in a practical and
popular way, sanitary subjects, were in-augurated
at Salisbury in 1893. Since
that time similar meetings have been held
in order at Washington, Charlotte, Golds-boro,
Winston-Salem, and Wilson. We
have been assured that they were helpful
in promoting the cause they were de-signed
to serve, but it must be confessed
that appreciation by the people of these
efforts on the part of the Board has not
increased, the first two having been the
most successful. It is true that rival at-tractions
of a more entertaining character
have interfered on three occasions, and
they may have been the explanation of
the comparatively small attendance, al-though
it has invariably been excellent
in quality and respectable in numbers.
It certainly cannot be attributed to a
falling off in the quality of the work done
by the members of the Board participa-ting,
as the papers and addresses were
never better, if so good, as those present-ed
at the last conference at Wilson, the
announcement and programme of which
was as follows
HEALTH CONFERENCE AT WILSON
.NOVEMBER 1, 1899.
AIMS AND OBJECTS.
The Conference is intended to be be-tween
the members of the State Board of
Health and the people. Its object is to
interest the people in sanitary matters by
explaining and impressing upon them the
great importance to the individual and to
the community of a strict observance of
the laws of health. Its proceedings will,
therefore, be not technical but popular in
character, and every one present will be
invited to participate therein, by taking
part in the discussions and by asking
26 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
questions, which the members of the
Board will take pleasure in answering to
the best of their ability.
As the enforcement of sanitary rules in
the family is largely in the hands of the
mistress of the household, the ladies are
especially invited to attend.
Papers or addresses are promised on
the following subjects:
Old Age and How to Attain it.—By Dr.
J. L. Nicholson, Richlands, member of
the Board.
Vaccination as an Economic Measure.—
By Dr. Henry H. Dodson, Milton, mem-ber
of the Board.
Malaria and Mosquitoes.—By Dr. Rich-ard
H. Lewis, Raleigh, Secretary of the
Board.
A Discussion of the Health Lairs now
Operative and, Reasons why they should be
Earnestly Supported by the Public.—By Dr.
George G. Thomas, Wilmington, Presi-dent
of the Board.
The North. Carolina Health Law and the
Local Health Officer.—By Dr. Henry W.
Lewis, Jackson, member of the Board.
Practical Hints on Drinking Water.���By
Dr. W. T. Pate, Gibson, one of the Bac-teriologists
to the Board.
There will be a Question Bos, and per-sons
in the audience too modest to speak
out in meeting can write them out and
deposit them in the same for answer by
some member of the Board. Opportunity
will be given for this at the end of the
discussion of each set subject.
The meetings will be held in the court-house
at 10 a. m. and 7:30 p. m.
You are cordially invited to attend and
bring your friends.
Richard H. Lewis, M. D.,
Secretary.
N. B.—The subjects will not necessarily
come up in the order in which they ap-pear
above.
In view, however, of the sacrifice in
time and labor required of the members
of the Board, and the expense incident
to the meetings, it is a question as to
whether they should not be discontinued.
An expression of opinion by members of
the profession outside of the Board would
be welcomed.
COUNTY SUPERINTENDENTS OP HEALTH.
In planning the construction of our
health laws, the County Superintendent
of Health was made what might be called
the corner-stone. While the State Board
is, in a general way, in charge of all mat-ters
relating to the public health, it has
only advisory powers, and the actual
practical work must be done by the Su-perintendent.
In a word, a county with-out
a superintendent has no sanitary
organization, and the health laws cannot
be applied to its people. In spite of every
effort, until recently, a considerable num-ber
of counties have utterly ignored the
law commanding them to elect a Super-intendent.
For years the number of
counties having Superintendents was less
than 70, then by special effort it was
raised to eighty-odd. At the time of our
last meeting there were eleven counties
having no health officer. The Board, at
a meeting held at the time of the Confer-ence
at Wilson, realizing their utter help-lessness
in case of the introduction of
small-pox, which they anticipated would
become widespread, instructed its Secre-tary
to write to every County Commis-sioner
in the derelict counties individu-ally,
calling attention to these facts, and
urging the importance of the immediate
election of a Superintendent. The Sec-retary
was also instructed to write to the
Judge holding the nearest court in said
counties, asking him to charge the grand
jury on our health law, and to suggest
the indictment of the commissioners re-
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 27
fusing to perform their duty. At the
same time, a letter to even* commissioner
in the State setting forth the importance
of making preparations for the probable
appearance of small-pox, was ordered. I
wrote to one Judge, but whether he acted
upon our request or not, I have never
learned. The letters were sent to the
Commissioners and eight new Superin-tendents
were elected, so that now only
three counties—all very small— Camden.
Pamlico, and Tyrrell, have no health of-ficer.
The value of this official is coming
to be more and more appreciated every
day, thanks chiefly to small-pox, and it
is to be hoped that in time, he will be
adequately remunerated for his services.
Some counties, I am glad to say, have
shown a disposition to do this by paying
the Superintendent $10 a day when en-gaged
in small-pox work, although it
must be admitted that more pay less, and
that many add nothing to the regular
pittance.
THE OUTSIDE INSANE.
While the insane constitute a class of
their own under the special care of other
guardians, they cannot be properly ig-nored
in a general consideration of the
public health. Although our State has
made generous provision for these unfor-tunates
in three well-equipped and admi-rably
managed hospitals, the present ac-commodations
are not adequate for the
care of all who need it. Basing an opin-ion
upon the recent excellent report of
the State Board of Public Charities on
this subject, which gives the number of
insane, epilectics and idiots located at
766, it is not unreasonable to assume that
there are at least one thousand of these
stricken ones in jails, county homes and
private families. It would be a work of
supererogation to detail to a body of
medical men, who are only too familiar
with such sad sights, the horrors of the
situation of many of them. No matter
how good the intentions of their keepers
may be, they cannot obtain the care and
attention to which, as a matter of simple
humanity, they are entitled, owing to the
lack of facilities and of knowledge and
experience in this particular kind of
work on the part of those in charge. By
a comparatively inexpensive amplifica-catiou
of our three State hospitals, all of
the insane and mostof the epileptics could
be given expert care and treatment at a
cost, in the aggregate, very much less than
that incurred under the present system.
It is to be hoped that the next Legisla-ture
will take action in this matter, and,
as our law-makers are largely influenced
by public opinion, it seems to me that
the adoption of a resolution setting forth
the views of this body, which represents
the medical profession of the State would
be in order.
PURE FOOD AND DRUG CONGRESS.
By appointment of the President I at-tended,
as a delegate from this Board, the
third annual session of the National Pure
Food and Drug Congress, which was held
at Washington, March 7—9. The meet-ing
was largely attended by representa-tives
of all the interests involved from all
parts of the United States. After a very
full discussion of the relative merits of
two bills setting forth the objects sought,
which had been introduced in the House
of Representatives by the Honorable
Messrs. Brosius and Babcock, respect-ively,
it was decided that the Brosius
bill was the more satisfactory, and it was
adopted as embodying the views and
wishes of the Food Congress. The out-look
for desirable legislation on this line
is said to be favorable, if action can be
obtained at this session. 1 would, there-fore,
respectfully suggest that a resolution
calling attention to the importance of the
28 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
subject, and asking the support of the
Brosius bill by our Senators and Repre-sentatives
in Congress be adopted by the
conjoint session and forwarded to them
at once.
small-pox.
The history of small pox in the State
for the past twelve months has been an
almostjexact repetition of that of the pre-ceding
year, in every respect, except the
number of cases, which has been nearly
five times as great.
An exact comparative statement is as
follows:
From January 12, 1898, to May 1, 1899—
Number of cases (in 38 counties), white,
162; colored, 454; total, 610.
Number of deaths, white, 8; colored,
9; total, 17.
Death rate, per cent., white, 4.93; col-ored,
1.97; total, 2.70.
From May 1, 1899, to May 1, 1900—
Number of cases (in'55 counties), white,
731; colored, 2,075: total, 2,800.
Number of deaths, white, 35; colored,
30; total, 65.
Death rate, per cent., white, 4.78; col-ored,
1.44; total, 2.31.
From this'statement it appears that the
proportion between the two races is al-most
exactly the same, the number of
colored attacked'being nearly three times
as large as the number of white in both
periods. The'death rate has remained
also nearly the same—a trifle less—the
decrease being slightly more marked in
the colored race.
The character of the disease has, as a
rule, been very mild, and from that fact
have arisen nearly all the difficulties in
the management; the indifference, and
often positive opposition, on the part of
the people to vaccination: the reluctance
of the authorities to institute and support
effective measures of prevention ; and the
mistakes in diagnosis, including the dis-astrous
effect upon public opinion of the
efforts of the physicians making the mis-takes
to support their position. From
the last of these three things has come
the chief trouble. The matter has been
so fully discussed in various issues of The
Bulletin during the year that I will not
weary your patience by a repetition of it,
but will merely cite two instances: the
counties of Guilford and Rockingham.
In both these counties the disease was
diagnosed chicken-pox by the attend-ing
physician, and in the latter the po-sition
was persisted in, notwithstanding
the opinion to the contrary of an expert.
In consequence, the proper precautions
were not promptly taken, and the result
was, in Guilford 509 cases with 9 deaths,
and in Rockingham 520 cases with 20
deaths, to which should be added the
direct cost to the counties of thousands
of dollars in handling the widespread
epidemics, and the loss of tens of thou-sands
in trade. In justice to the Super-intendents
of both these counties, it
should be said that the harm in the way
of numberless exposures of unvaccinated
persons was done before the disease was
reported to them as small-pox, when
only their responsibilities began. I have
no reason to believe otherwise than that
they are both good men, and efficient
health officers.
The work of our two inspectors, Drs.
Joshua Tayloe, of Washington, and L.
Harrill, of Statesville, wmose reports are
attached, has been of great value in set-tling
disputed diagnoses, instructing
Superintendents new at the business, im-pressing
upon the authorities the gravity
of the situation, and explaining the best
way to meet it.
In response to special requests from
Greensboro, Winston, and High Point,
for a United States expert, I asked Sur-geon-<
General Wyrnan, of the Marine
BULLETIN OF THE NORTH CAROLINA BOARD <>! HEALTH. 29
Hospital Service, to send one of his men
to those points. He promptly granted
my request, and sent Passed Assistant
Surgeon Wertenbaker, whose efforts were
of material aid in setting public opinion
right, and in inaugurating the proper
precautions.
Upon the occurrence of a case of sus-pected
smallpox in one of the students,
I personally visited the University, at
the request of President Alderman and
Dr. Whitehead. I confirmed the diag-nosis
of small-pox already made by Dr.
Whitehead, endorsed the precautionary
measures already planned and in part in-augurated
and addressed the student
body, particularly upon the value and
importance of vaccination. The entire
absence of panic among the 500 students,
and the failure to spread from the first
case under such circumstances, is suffi-cient
testimony to the admirable man-agement
of those in charge there. I also
personally visited Reidsville, at the urgent
and repeated request of Superintendent
Ellington, to aid him in securing the co-operation
of the County Commissioners
with those of the town. I addressed
both bodies in joint session, and was
much gratified to learn that the County
Commissioners took action in the manner
desired immediately upon adjournment.
and to be assured since that my visit was
really helpful.
Owing to the extreme mildness of the
disease in many instances, no physician
has been called in, and absolutely no
precautions in the way of disinfection
have been taken. This means, of course.
a great many foci of infection for time to
come. According to the reports of the
Superintendents, hardly more than 10
per cent, of the people have been vacci-nated
on an average, though it should be
said to the honor of this county of Edge-combe,
whose hospitality we are now
enjoying, that she heads the list in this
good work with 80 per cent of her entire
population, rural as well as urban, vacci-nated.
The conclusion from these two
facts is inevitable. There must be a re-crudescence
of small- pox next winter,
unless the people are generally vaccina-ted
between now and then on a much
more extensive scale. Since the decision
of the Supreme Court, in State Appellant
v. W. E. Hay from Alamance, affirming
the right of county and municipal au-thorities
to enforce compulsory vaccina-tion—
a copy of which opinion, delivered
by Justice Clark, was printed in the
March Bulletin—-there need be no
trouble about it. The responsibility rests
upon the said authorities. Let us hope
they will meet it. And in this connection,
let me say one word as to the duty of the
medical profession in the premises. It
is clear. They should, without ceasing,
teach, preach and practice vaccination,
and cordially support all authorities try-ing
to bring it about.
In conclusion, I would say that the
Board of Health, owing to the small-pox
epidemic and the outbreak of fever at
the Normal and Industrial College, has
never been so much in evidence, and,
apparently, so much appreciated by the
people as during the past year.
30 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
RECORD OF SMALL-POX IN NORTH CAROLINA FROM MAY 1st, 1899,
TO MAY 1st, 1900.
Counties.
Alamance
Alexander
Anson
Bertie
Buncombe
Burke
Cabarrus
Caldwell
Carteret
Caswell
Catawba
Chatham
Cherokee
Chowan
Cleveland
Craven
Cumberland .
Currituck
Davidson .
Davie
Durham
Edgecombe ....
Forsyth
Gaston
Gates
Granville
Guilford
Halifax
Harnett
Haywood ,
Henderson
Hertford
Iredell
Johnson
Mecklenburg..
Moore
Nash
New Hanover..
Northampton .
Orange
Pender
Person
Randolph
Richmond
Robeson
Rockingham..
Rowan
Rutherford
Stanly
Surry
Utuon.
Vance
Wake
Warren
Washington.
White. Colored. Total. White. I Colored. Total.
15
144
40
1
1
105
30
12
I
1
j
34
•21
19
1
4
8
HHl
44.1
150
24
48
76
24
15
14
24
8
14
7
29
15
376
130
60
s\
12
8
1
26
62
12
30
19
33
61
13
13
1
39
1
95
1
33
13
1
1
24
45
29
21
1
12
8
118
1
509
162
8
32
1
4::
1
39
.50
92
46
16
14
44
8
40
18
29
30
520
170
61
24
117
8
3
31
2
1
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 31
REPORT OF SMALL-POX INSPECTORS.
REPORT OF DR. TAYEuE.
Dr. R. H. Lewis, Secretary,
State Board of Health,
Raleigh, N. C.
Sir:—I submit herewith to the State
Board of Health the following report of
my work as Small-pox Inspector, from
May, 1899, to May, 1900. In this report
I give the towns, counties, number of
cases examined, how managed and by
whom. Also what precautions had been
taken up to my inspection.
May, 1899—I made a trip to Gates
county, this being my first inspection,
examined a good many patients suffering
from the mild forms of small-pox, two-thirds
being white people. There existed
in Gates county, at the time of my visit,
thirty-five infected houses. No precau-tions
had been taken. No superintendent
of health.
May, 1899—I inspected the conditions
in Currituck county. Saw six cases, two
white and four colored, in charge of Dr.
H. M. Shaw, Superintendent of Health.
Some precautions had been taken.
June 23, 1899—Hertford county, at
Ahoskie, I examined three cases, negroes,
in charge of Dr. Tayloe, Superintendent
of Health. They were well cared for.
Scotland Neck, Halifax County—
Five cases were examined by me, all
negroes. More negroes afterwards de-veloped
the disease, also some whites.
No precautions had been taken until the
time of my inspection, as a positive diag-nosis
was not made until then. Dr.
Green, Superintendent of Health, then
took charge, and with the assistance of
Dr. Wimberley, managed the cases well.
June ?>, 1899
—
Beaufort, Carteret
County—Examined one case, white.
Well managed by Dr. Frank Clark,
Superintendent.
March 29, 1900—Robeson County—In-spected
eight cases, five white and three,
colored. Some precautions had been
taken. Drs. McNatt and Utley in charge.
Henderson, Vance County—I inspect-ed
one case, white. All necessary pre-cautions
had been taken by Drs. Cheat-ham
and Bass, Health Officers.
April 1, 1900—Selma, Johnston
County—Thirteen cases were inspected
by me, seven white and six colored. Of
these two suffered with confluent type,
one died. Moderate precautions had
been taken by Drs. Wharton and Noble,
health officers of county and town re-spectively.
April, 1900—Franklin County—In-spected
four cases, all colored. Proper
precautions were at once taken by Dr.
Foster, Superintendent.
Small-pox has existed during this epi-demic
in all its forms, from the mildest
varioloid to the most malignant confluent
type, as expressed by Dr. Long.
In every town and county in which 1
made inspections I made reports to the
Town and County Commissioners and
Local Health Boards, advising them as to
the best possible means of stamping out
and controlling the disease, without
further spread. Also described the full
technique of caring for patients and
handling suspects, suggesting as thorough
vaccination as possible in every section
which I visited.
I advocate vaccination because I believe
it to be the most powerful means of pre-venting
the disease. I regard vaccine
virus as the most active material that can
be admitted into the list of our prophy-lactic
remedies, and the only weapon of
defence in overcoming the worst of
human maladies.
The large majority of small- pox in the
State has existed in a very mild type, in
fact, the virtue of vaccination has so
32 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
modified the disease that it is only in
exceptional cases we have the oportunity
of studying the malignant forms. I have
had the oportunity in the present epi-demic
to examine only a few cases of the
malignant forms of small-pox, and I am
firmly of the opinion that such types of
the disease can only exist in those who
are absolutely without history of vacci-nation,
and I mean by that, those whose
parents and grandparents have not been
vaccinated.
The protective influence of vaccination
is so great that, from my experience, I
am willing to assert that the vaccinated
can only contract the disease by close and
continuous contact or exposure. And if
contracted then, it is of a mild and modi-fied
form.
Respectfully submi tted
Joshua Tayloe, M. D.,
Small-pox Inspector.
Washington, N". C, May 21st. 1900.
REPORT OF DR. HARRII.L.
Statesyille, N. C, May 19, 1900.
Dr. R. H. Lewis, Secretary,
State Board of Health.
My Dear Doctor: —-At your request I
hereby submit a statement of visits made
by me as Inspector. My appointment
was made about the middle of January
fest.
January 20—I visited New London,
Stanly county, where I found seven cases
of small-pox, colored.
February 4—At Thomasviile, I saw two
eases, colored.
February 10—At Asheville, I saw twelve
cases, whites.
February 20 to 22—Near AValnut Cove,
Stokes county, saw two cases besides six
or eight others recovered, and in the
same county, at Pinnacle, saw three cases.
A local doctor refused to accept my diag-nosis.
The leading case, and the one
upon which I based my opinion, was in
a woman, forty to forty-five years of age.
with an eruption about nine days old
when I saw her. The cases at Walnut
Cove and Pinnacle all white people.
February 23—I saw one case at Pilot
Mountain. I visited Reidsville and saw
the celebrated cases in a seminary there.
I have been informed that persistant
efforts were made by a local physician to
discredit my opinion. Repeated vacci-nations
were made, but without results.
I am informed that one of the patients
afterwards carried the contagion to her
home in some of her clothing, and from
this source there were two malignant
cases resulting in death. I saw in Reids-ville
twelve to fourteen cases, but the
actual number at that time was probably
three or four times as many.
February 24—Visited Hillsboro. Saw
two cases.
March 2—Visited Taylorsville and
found six cases, all whites Dr. H. F.
Long also saw one of these cases, and
confirmed my diagnosis.
March 24—I visited Jonesboro and
found six case- in one family, all white.
The mother and grandmother in the same
house had both been vaccinated when
young, and both escaped the disease. I
saw one other white man and two negroes
with the disease.
Ai'Kii. 16—Visited Shelby and found
six cases in the same family of negroes.
Another family of negro children had
chicken-pox. AtFallston, in same county,
1 saw one case in a white man. At
Mooresboro, one case, a negro man. Near
Cleveland Springs, same county. I saw-one
case, a negro woman.
April 27—Visited Henrietta. Ruth-erford
county, where I saw three cases,
all negroes. One case reported at Caro-leen,
and one west of Rutherfordton that
I did not -
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 33
April 30—Visited Spray and saw three
cases, all whites, besides several recovered
and convalescent cases that I believe were
the same disease.
May 1—Visited Madison and found that
small-pox had been there four to sis
weeks. I saw one partly confluent case
here. There had been in all about fifteen
cases.
May 2—Visited Stem, Granville county,
and found one case only developed, but
a number of exposures.
This closes my list of official visitations.
There is a strong prejudice against vacci-nation,
and decided opposition to any
restriction or isolation of patients. Also
a determination to not believe there is
any small-pox in the State. Unfortu-nately
this belief extends to some of the
doctors, and when one or more of that
kind are in a community it is almost im-possible
to control the disease. I per-suaded
one doctor, a non-believer in vac-cination,
to go with me within thirty or
forty feet of a- well developed case. After
seeing it. he decided that as be was
practising in the neighborhood, and had
never been vaccinated, lie ought to be.
In communities where the disease has
been for several months, it is to be feared
that there is already, and will continue
to be. a relaxation of proper efforts to
stamp out the disease.
Public meetings have been called in
many places, and I have tried to advise
the people about vaccination and other
neccessary regulations. Hoping this im-perfect
report will be satisfactory, I re-main.
Yours very truly,
L. Harrill, M. 1> .
Smallpox Inspector.
RESO] UTIONS ADOPTED.
The following resolutions were adopted
by the Conjoint Session of the Shite Board
of Health and the State Medical Society:
IN REGARD TO PURE FOOD, BY COL. A. W. SHAFFER.
Whereas, The health of the people is
largely dependent upon the purity of
their food and the reliability of their
medicine, and is injuriously affected by
the adulterations now so common in very
many of the articles in daily use; and
Whereas, A bill to prevent such inju-rious
adulterations, introduced by the
Hon. Mr. Brosius, is now pending in
Congress; therefore be it
Resolved, by the North Carolina Board
of Health and the Medical Society of
the State of North Carolina, in conjoint
session assembled, that our Senators and
Representatives in Congress be requested
to give this measure their prompt and
cordial support,
IN RECiARD TO OUTSIDE INSANE, BY I'll. HENRY
\Y. T.KWIS.
Whereas, Recent official reports from
the State Board of Charities show that
there are in North Carolina, uncared for
in asylums or other proper institutions,
insane, epileptics and idiots to the num-ber
of 766, and that there are probably
as many more in the State who have not
been reported; and
^Yuereas, It is a notorious fact that
many of these people are confined in jails
and county homes without proper care
and attention, and undergo hardships
and in many cases maltreatment—which
of itself precludes the hope of improve-ment
or recovery from their mental or
physical condition; therefore be it
Resolved, 1st. That the paramount con-sideration
is that these patients have
proper treatment at the hands of the
State of North Carolina, whereby the re-proach
now resting on US may he removed.
2d. That it being notorious that the
State institutions are already overcrowd-ed,
we urge the pressing necessity of such
early increase of hospital facilities as will
insure these proper care and treatment,
34 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
and to this end we commend the plan
referred to by Dr. P. L. Murphy, in his
paper read before the students of the A.
& M. College at Raleigh, March 16, 1900—
said plan being known as "The Cottage
System."
IN REGARD TO SMALL-POX, BY DR. B. WESTRAY
BATTLE.
The total number of cases of small-pox
in the State for the year from May 1, 1899,
to May 1, 1900, was 2,806, as against 616
for the fifteen and a-half months prece-ding—
from the beginning of the epidemic
on January 12th, 1898, to May 1st, 1899,
an increase of 455.5 per cent. This means
innumerable foci of infection, which
in an indefinite number of instances,
owing to entire neglect or imperfect prac-tice
of disinfection, are and will continue
for months or years still active. Reports
from Superintendents of Health show, on
an average, about 10 per cent, only of the
people as being vaccinated. The people
seem to be general^ indifferent or ac-tively
opposed to vaccination. The au-thorities,
county and municipal, except
in the actual presence of small-pox, do
not appear to realize the gravity of the
situation and the dangers which menace
their people. In view of these facts,
be it
Resolved, by the North Carolina Board
of Health and the Medical Society of the
State of North Carolina, in conjoint ses-sion
assembled, that it is their opinion
that in the present conditions the con-tinued
spread of small-pox is inevitable,
with the strong probability of its reach-ing
pestilential proportions during the
coming winter, small-pox being much
more virulent in cold weather;
That quarantine and disinfection in
the present state of public opinion, and
in view of the lukewarm support, to say
the least, too often given the health offi-cer,
cannot be depended upon to prevent
the spread of the disease;
That the thorough and complete vacci-nation
of all the people is alone adequate
to meet the situation;
That this, in most instances can only
be accomplished by compulsion, legal
authority for which has been affirmed in
the recent decision of our Supreme Court
in State v. Hay;
That we feel it to be our duty to notify
the people of these facts, and the grave
dangers which threaten them, and to call
upon those who represent their interests,
the various boards of county commission-ers,
boards of city aldermen and town
commissioners to take at the earliest prac-ticable
moment the necessary steps to
secure the vaccination of the people, and
we urgently appeal to our professional
brethren throughout the State, individ-ually,
as well as collectively, to render
every aid in their power, by both word
and act, to the accomplishment of this
most important object.
A resolution in favor of establishing
the Appalachian Park was introduced
and adopted, and copies ordered sent to
our Senators and Representatives.
Death of Dr. Cheatham.
It is with much regret that we chronicle
the death on the 23d instant of Dr. "VV. T.
Cheatham of Henderson. Dr. Cheatham
was one of the prominent physicians of
the State, having been for many years a
leading practitioner in his community,
and in 1892 President of the State Medi-cal
Society. At the time of his death he
was Superintendent of Health of his
county.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 35
Review of Diseases for May. 1900.
EIGHTY-SIX COUNTIES REPORTING.
Ninety-three counties have Superinten-dents
of Health.
Except in the case of the more con-tagious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of May the following
diseases have been reported from the
counties named
Measles.—Alamance, 30 ; Ashe, 6
Bertie, general ; Bladen ; Brunswick,
3 ; Caldwell, 1 ; Caswell, several ; Chero-kee,
many ; Chowan, 3 ; Clay, 1 ; Cleve-land,
a few; Columbus; Craven, 24;
Currituck, 2; Dare, epidemic, severe;
Forsyth, general; Gates, 20; Granville,
10 ; Greene, 100 ; Halifax, 10 ; Harnett,
a few ; Hertford, 4 ; Hyde, 1 ; Johnston,
14 ; Martin, 50 ; Moore, 4 ; Nash, epi-demic
; New Hanover, 170; Northamp-ton,
many ; Onslow, 3 ; Pasquotank, 25
Pender, 6 ; Perquimans, 26 ; Pitt ; Robe-son,
epidemic ; Rockingham ; Surry, 6
;
Swain, 12; Wake, 43; Washington, 44;
Watauga, general—41 counties.
Whooping-cough.—Beaufort, 3; Burke,
8 ; Cabarrus, many ; Caldwell, 10 ; Cleve-land,
a few ; Columbus ; Craven, 25
Currituck, 7 ; Gates, 20 ; Graham several
Granville, 10 ; Greene, 50 ; Halifax, 15
Hertford, 3 ; Jones, several ; Macon
Madison, 50; Martin, 50; Mecklenburg,
15 ; Nash, epidemic ; New Hanover, 6
;
Perquimans, 2 ; Richmond, many ; Wake,
25; Washington, 2; Watauga, general
—
26 counties.
Scarlatina.—Craven, 1 ; Rockingham.
Diphtheria.—Pitt, 1.
Typhoid Fever.—Alamance, 7 ; Ashe,
3; Beaufort, 2; Burke, 4; Chowan, 2
Craven, 2; Currituck, 2; Halifax, 2
Harnett, a few ; Haywood, 4 ; Johnston
3 ; Macon, 1 ; Mitchell, a few ; Nash, 1
Onslow, 1 ; Pender, 1 ; Perquimans, 2
Pitt, 1 ; Richmond, 1 ; Rockingham
Union, 3 ; Wake, 3 ; Watauga, 1 ; Wayne,
1 ; Wilson, 1—25 counties.
Malarial Fever.—Alamance, Cabar-rus,
Currituck, Dare, Gaston, Halifax,
Hertford, Johnston, Jones, Martin, Ons-low,
Orange, Perquimans, Person, Wash-ington,
Wayne, Yadkin—17 counties.
Malarial Fever, Pernicious.—Johns-ton,
4 ; Jones, 2.
Malarial Fever, Hemorrhagic.—
Hertford.
Influenza.—Bladen ; Brunswick, gene-ral
; Cleveland ; Graham ; Lenoir ; Lin-coln,
general ; McDowell ; Mecklenburg
;
Onslow; Pitt; Randolph, epidemic;
Sampson ; Transylvania ; Wake ; Wilson,
general—16 counties.
Pneumonia.—Brunswick ; Cherokee ;
Gates, much, of severe type ; Jackson
Lenoir ; Pitt ; Randolph ; Wilson ; Yad-kin—
9 counties.
Diarrheal Diseases.—Bladen, Bruns-wick,
Burke, Cabarrus, Chatham, Colum-bus,
Currituck, Dare, Davidson, Gaston,
Granville, Greene, Halifax, Hertford,
Jones, Lincoln, McDowell, Mecklenburg,
Moore, Northampton, Onslow, Pender,
Perquimans, Person, Pitt, Robeson, Rock-ingham,
Rutherford, Surry, Transylvania,
Union, Vance, Wake, Wilkes—34 coun-ties.
Mumps.—Sampson, Watauga, Yadkin.
Roseola.—Lincoln, epidemic.
Rotheln. —Sampson.
36 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Small-pox.—Alamance, 2 ; Burke, 12 ;
Cabarrus, 3 ; Caswell, 10 ; Chatham, 1
;
Cleveland, 5 ; Davidson, 1 ; Davie, 9, one
a child five weeks old ; Durham, 8 ; For-syth,
8; Franklin, many, of mild type,
in one section, no new cases for several
weeks ; Granville, 21 ; Guilford, 22 ; Hali-fax,
1 ; Haywood, 5 ; Henderson, 4 ; Hert-ford,
1 ; Johnston, 16 ; Mecklenburg, 20
;
Nash, 2 ; Orange, 7 ; Person, 4 ; Randolph,
3 ; Rockingham, 131 ; Rutherford, a few
—
25 counties.
Cholera in Fowls.—Chatham.
Cholera -in Swine.—Hyde.
Distemper in Dogs —Jackson.
Distemper in Horses.—Ashe, Burke,
Cleveland, Macon, Swain.
Hydrophobia in Dogs.—Ashe.
No diseases are reported from Alexan-
Buncombe, Carteret, Edgecombe, Iredell,
Warren and Yancey.
No reports received from Alleghany,
Anson, Cumberland, Duplin, Mont-gomery,
Rowan and Stanly.
Summary of Mortuary Reports for
May, 1900.
(eighteen towns).
Only those towns from which certified
reports are received are included.
White. Col'd. Total.
Aggregate popula-tion
70,901 51,599 122,500
Aggregate deaths... 60 103 163
Representing tem-porary
annual
death rate per
1,000 10.1 23.9 15.9
Causes of Death.
Typhoid fever 12 3
Malarial fever 112 Whooping cough... Oil Measles 4 4
Pneumonia 5 7 12
Consumption 9 18 27
Brain diseases 2 13 Heart diseases 14 5
Neurotic diseases... 11 Diarrhceal diseases 7 S 15
All other diseases.. 33 53 86
Accident 134
60 103 163
Deaths under five
years 23 28 51
Still-born _ 7 9 16
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 37
Mortuary Report for May, 1900.
'OPULA-rios.
temporary
Annual
Death PiATE
PER 1,000. - Q S
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
County Superintendents of Health.
Alamance Dr. T. S. Faucette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dunstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. R. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. S. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuVal Jones.
Cumberland Dr. J. Vance McGougan.
Currituck Dr. H. M. Shaw.
Dare Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. O. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. J. W. Sain.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell.. Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-ly
°
house.
Polk Dr. Earle Grady.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland
Stanly Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. J. J. L. McCullers.
Warren Dr. T. B. Williams.
Washington Dr. W. H. Ward.
Watauga Dr. E. F. Bingham.
Wayne Dr. William Spicer.
Wilkes Dr. J. W. White.
Wilson Dr. W. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancey Dr. W. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 39
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis-
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks: __. _
M. J).
190.— N. C.
BTTX-.X-.ETXILT
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, N. C.
Geo. G. Thomas, M. D., Pres., Wilmington.
S. Westray Battle, M. D...Asheville.
Henry W. Lewis, M. D Jackson.
Henry H. Dodson, M. D Milton.
C. J. O'Hagan, M. D Greenville.
J. L. Nicholson, M. D Richlands.
Albert Anderson, M. D Wilson.
A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary mid Treasurer, Raleigh.
Vol. XV. JULY, 1900. No. 4.
Mosquitoes and Malaria.
Read before the Raleigh Academy of Medicine by
Gerald McCarthy, Entomologist of the N. 0. De-partment
of Agriculture.
It is scarcely necessary, before an au-dience
like the present, to allude to the
scourge-like character of malaria in all
warm moist countries.
Malaria we know to be a germ disease.
The specific germ causing malaria in
humans was first described by Laveran
in 1880. Subsequently other investiga-tors,
chiefly in Italy, took up the study
of the etiology of the disease. Golgi,
in 1885, found what he supposed was the
same parasite in the blood of birds suf-fering
from fever. The German Koch,
and other of his countrymen, have ad-ded
much valuable work, but it is to the
British army surgeon, Ronald Ross, that
we owe the final clearing up of the sub-ject
and a most convincing demonstration
of the method in which malaria is spread.
It is well known, alike to the medical
profession and to laymen, that most
swampy regions in warm countries are
malarious in summer time. It is said in
a loose sort of way that such swamps
breed malaria. But we know that ma-laria
is due to a protozoan parasite in the
blood stream. This parasite has never
been isolated from swamp or any other
natural water. According to the re-searches
of Ross and numerous collabo
rators in Italy and Germany, the parasite
of human malaria is never found but in
the human body and in certain organs of
mosquitoes of the genus anopheles. Ross'
work is not a year old. It has created a
most profound sensation among economic
entomologists and those who have to do
with public health.
Entomologists are now busy in most
regions where malaria is endemic in
studying the species of anopheles found
therein. So far publications show that
this genus is very poor in species, and
that the number of individuals belong-ing
to any species of anopheles ia in any
particular region few in comparison with
the individuals of the genus culex. < 'id, x
is everywhere the common mosquito. It
is concerned in spreading the malarial
42 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
disease of birds, but so far, the parasite
of human malaria has not been found in
any species of culex. Before we go
further, I may say that entomologists
classify mosquitoes into five genera, of
which three are rare and of no economic
importance. The remaining genera are
culex, of which we have in the United
States about twenty-two species, of which
seven are known in North Carolina. Of
anopheles we have in the United States
only three species, so far as known. All
three of these occur in North Carolina.
If I should go out and capture 1,000
mosquitoes anywhere in this v : cinity,
from 900 to 999 of them would probably
belong to culex, the remainder to ano-pheles.
Now as to the method in which the in-sect
propagates the parasite. It would
seem reasonable that if a drop of human
blood containing the malarial parasite
be injected into a vein of a healthy per-son,
not immune, the parasites will mul-tiply
in the body of the new host and
produce malarial fever of the same va-riety
as in the person from whom the
blood was taken. Therefore any insect
whatever which should suck the blood
of a malarial patient may transmit the
disease by afterwards puncturing a blood
vessel of another person. In practice,
however, it is found that malaria is not
transmitted in this way by any mosqui-toes
except anopheles. It seems that
the protozoans, which adhere to the
puncturing apparatus of the insect, rap-idly
perish in the free air and are dead
before the insect finds an uninfected per-son
to bite.
The parasites of human malaria exist
in the blood stream at first in the form
of amoeboid, motile jelly dots. They
grow fast and usually in from one to three
days attain full size. They then pass
into the spore form as sporocytes and
gametocytes. The sporocyte is the asex-ual
form. It at once begins to form a
sort of capsule in which appear asexual
spores. These spores, according to the
species, mature in from one to three days.
The capsules then burst, the spores fall
into the serum and soon after assume the
amoeboid form. They move about in
the blood serum until they find a red cap-sule
to attack. The bursting of the spore
sacks and the storming of the blood cor-puscles
by the new generation of proto-zoans
is correlated to the period of recur-rence
of the fever, and is the cause of the
same.
The gametocytes are the sexual form.
They do not undergo any further change
in the human body except as they may
degenerate and die. They may, in this
way, circulate in the blood stream for
days and weeks. If a mosquito of the
genus anopheles sucks the blood of a
person in whose blood stream the game-tocytes
are circulating the cysts as soon
as they reach the fore crop of the insect
burst. The microbe resumes the cycle
of its development. Some of the cysts
produce male, some female germs. These
coalesce and the result is a new individ-ual
or zygote. These grow rapidly, are
very active and repel the attacks of the
phagocytes of the human blood in which
they were borne into the alimentary tract
of the insect. The zygotes soon bore
through the stomach walls of the mosqui-to
and fix themselves upon the external
surface in the form of oval cells of from
8 to 10 micromillimeters in diameter.
These cells subdivide much like the egg
of a vertebrate, and eventually form a
capsule full of small spores—each cap-sule,
when mature, is 60 micromillime-ters
to 80 micromillimeters in diameter,
and may contain several thousand spores.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 43
The whole process from the time the
gametocyte enters the body of the insect
until the spores are formed is about ten
to twelve days in summer. It is longer
in cooler weather. These sexual spores are
motile and move about until they reach
the blood stream of the insect. In this
they are carried into the salivary glands.
AVhen snch a mosquito bites a person she
injects into the wound some of the saliva
and with it the spores of the proto-zoan.
These once in the human blood
stream assume the amceboid form from
which we started, and so begins a new
cycle.
It may be asked what becomes of ga-metocytes
which do not find their way
into the body of an anopheles. They
eventually degenerate and are eaten by
the phagocytes. The same fate, sooner
or later, overtakes the sporophytes in the
human blood. If, instead of anopheles,
it is culex, which receives the gameto-cytes,
so far as we know, the latter do
not develop further but are digested with
the blood in which they are imbedded.
Now a few words as to the classification
of the protozoan parasite.
The latest authors make two genera:
I. Htemamcebidse.
II. Hsemomenas.
The first genus contains four species.
Two of these produce malaria in birds.
The other two in man.
Hiemamceba malarias, causes quartan
fever.
Hsemamoba vivax causes tertian fever.
Hsemomenas has but one species.
H. pr:ecox (Laverania malarhe of older
authors).
It causes pernicious autumn malaria
in man.
The life histories above outlined are
not based upon theory, but upon micro-scopic
dissections. They are as true as
anything can be in science.
So much for the scientific portion of
our theme. Now for some practical ap-plications.
It is apparent, in the light of the new
knowledge, that too much stress has been
laid by hygienists upon the value of pure
water as a preventative of malaria. Since
the germ does not usually or at all exist
in water, it is, so far as this point is con-cerntd,
of no importance what one drinks.
It is certain that mosquitoes do die and
fall into wells and tanks, and when the
body dissolves the contained protozoans
will be set free. But we have seen that
the protozoan can exist very briefly, or
not at all, in air, and the same condition
will hold good as regards water. More-over
the anopheles mosquitoes never
breed in reasonably clean watei", or in
wells, tanks, or water barrels. They are
a peculiarly wild and ferocious race.
They breed only in retired pools which
are full of algse and aquatic plants. Rice
fields and sluggish streams, with numer-ous
permanent pools or holes, such as
we find along Walnut creek, are the
favorite breeding places of the anopheles
mosquitoes.
There is a wide-spread idea that the
tearing up of surface soil in hot weather
produces malaria. This cannot be true,
if by malaria we mean the specific dis-ease
due to the presence in the blood of
hsemamabida or hsemomenas. These
parasites do not exist in the soil, nor does
the mosquito, which harbors them, exist
there. *
It may be that several distinct diseases
are confused and included under the com-mon
name of malaria, or it may be that
impure water or emanations from freshly
turned soil break down the resist ing
power of the body against the parasite.
But since exhaustive and fully competent
research has failed to show the presence
44 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
of the protozoan, either in the water or
soil of notoriously malarious neighbor-hoods,
it is neither scientific nor just to
say that either soil or water can cause the
disease.
The second point to be emphasized, is
this:
Very few mosquitoes live over winter.
These few hibernate as adults. It is pos-sible
that some of these hibernating mos-quitoes
harbor the sexual spores of ano-pheles,
and may be able to start a new
epidemic of malaria the succeeding sum-mer.
But if this was the only way the
protozoans could pass from one warm
season to another the disease would die
out in many localities. The more com-mon
way of passing the cold season by
the parasite is, as spores in the blood of
persons who had acute malaria the preced-ing
summer. The spores are well known
to be very sensitive to the destructive pow-er
of quinine and methylene blue. If all
convalescents from summer or autumn
malaria were isolated or treated during
the winter with enough quinine or me-thylene
blue to kill the spores in their
blood streams the mosquitoes of the next
season would find no parasites to dissem-inate
and malaria must die out.
Of course the destruction of the pro-tozoans
in any section will not entail any
trouble upon the mosquitoes. The latter
are as much the victims of the parasite
as are mankind. To keep the malarial
parasite out we would have to quarantine
against every outsider not having a cer-tificate
of freedom from the parasite.
One infested person might start an epi-demic
and undo all the work of clearing
it out before.
Another point to be brought out is,
that mosquito screens upon doors and
windows and mosquito netting over beds
should form a part of all prescriptions
for epidemic malaria. The use of unguents
on the exposed parts of the person and
of smudges in or about the houses are
valuable preventives.
The best repellant for mosquitoes is
oil of pennyroyal. This may be mixed
in proportion of one part oil to fifteen or
twenty- five parts of lard or vaseline and
rubbed on hands, arms, neck and face.
The odor of pennyroyal is very persist-ent,
and a little will suffice. A small
uncorked phial of the same is a good
thing to keep in sleeping-rooms at night.
A strong onion, or, what is much better,
a clove of garlic, rubbed on hands and
face is very effective against mosquitoes.
Finally we come to the question of de-stroying
the mosquitoes, who are the
innocent agents for disseminating the
malarial parasite. It seems to me that
the reduction of the members of these
insects to the point of practical harmless-ness
is not only possible, but, when com-pared
with the cost of suffering and
treating malaria, comparatively small.
Since anopheles breeds only in remote
permanent pools or holes, we must seek
these out and with oil kill the breeding
larva-. I am personally of the opinion
that three-fifths or more of all the ano-pheles
mosquitoes bred in Raleigh town-ship
are produced in the holes made along
Walnut creek by the X. C. Penitentiary
in taking out clay to make brick. If
these holes were filled up or their surfaces
kept covered with a film of crude petro-leum,
there would be a very great reduc-tion
in the number of mosquitoes which
carry malaria. The filling up of mud
holes along Walnut creek and around the
rock quarry would do most of the rest.
In proposing to President Goodwin to
bring this subject before the Raleigh
Academy of Medicine, it was my inten-tion
to ask the Association to appoint a
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 45
committee to study the mosquito-malaria
theory from a local and experimental
stand-point. I hoped to be able to assist
in the microscopic dissections and make
specific identifications. But since then
changes have occurred which will proba-bly
cause my services to be transferred
to another field after September 1st, and
I shall be unable to follow up the matter
as I proposed. I have gathered numer-ous
testimony as to the relationship
between the mosquitoes named and mala-ria.
Personally, I am entirely convinced
that the relationship is real. This being
so, it seems to me to be well worth the
trouble and cost to make a practicable
trial of the measures I have suggested
for reducing the numbers of the parasite-harboring
mosquito.
I trust that the physicians of this city
and State will exert their influence upon
those who have the appointing power to
make some provision for making investi-gations
along this line. And such inves-tigations
to be of any value must be
based upon and bolstered by real work,
not talk or hearsay.
We are glad to have the privilege of
printing this very interesting paper of
Mr. McCarthy's, but we are not yet pre-pared
to accept all his statements, no
matter how accurate and scientific they
may be. We are a thorough believer in
the mosquito theory of malarial trans-mission,
but we still believe in the drink-ing
water theory, which Mr. McCarthy
flatly denies. The connection between
drinking water and malarial diseases is
so plain and so strong that it simply can-not
be ignored or broken. Knowing that
the female mosquito, the blood-sucker,
laid her eggs on the surface of stagnant
water, immediately died, sank to the
bottom and disintegrated, thereby liber-ating
in the water the germs of malaria;
and knowing that according to over-whelming
evidence persons drinking the
water of shallow, open wells, are much
more subject to malarial diseases than
other persons in identically the same
environment in every single respect, ex-cept
water, drinking the water of cis-terns,
driven pumps or bored wells, we
reconciled the two theories by taking it
for granted that the malaria-bearing
mosquito poisoned in the manner indi-cated
the shallow open wells.
Some years ago, as most of our readers
probably remember, the Board distrib-uted
widely throughout the malarious
sections of the State a pamphlet, entitled
"Drinking Water in its Relation to Ma-larial
Diseases," in which a large amount
of evidence showing the connection was
given. This pamphlet, we are gratified
to know, has borne abundant fruit in an
improvement in the domestic water sup-ply
in innumerable instances, with a
corresponding improvement in health as
regards the diseases of this class. Many
physicians in those localities scoff at the
assertion that malaria is not conveyed by
drinking water, for, as Uncle Remus
would say, " dey dun had de spe'unce
un it."
Mr. McCarthy meets the overwhelming
evidence in support of the drinking
water theory by saying that there may be
other diseases presenting identically the
same clinical features, but lacking the
Plasmodium in the blood. This of course
is a mere assumption—an assumption
that we believe would be disproved by
the microscope. Practically, however, it
is a matter of no moment whether the
parasite can be demonstrated in the blood
or not, if the clinical symptoms are iden-tical
and the remedy is the same. It
seems to us that before the mosquito
46 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
theory can be regarded as meeting all the
conditions the connection between the
mosquito and drinking water must be
established.
In reply to an inquiry as to how to
distinguish between the cule.% and the
anopheles varieties, Mr. McCarthy stated
that the simplest way was to observe
their behavior in stinging—that the culex,
or domestic mosquito, took his meals
squatting or sitting down, while the ano-pheles
regaled himself standing on his
head. So, that when we see a mosquito
with his bill in our skin and his heels in
the air we may know that he is a " wild
and ferocious" anopheles, and look out
for chills.
It is not our desire or intention to be-little
in any way the mosquito theory. As
we said in the beginning, we thoroughly
believe in it, considering it as practically
demonstrated, and therefore we desire
to endorse Mr. McCarthy's suggestions as
to wire screens, mosquito nets and the
drainage or covering with oil, during the
breeding season, of all stagnant pools.
Attention to these precautions and to the
character of the drinking water would,
in our judgment, reduce malarial dis-eases
to a minimum.
We would be greatly obliged to our
physicians in the malarial regions if they
would write us their experience and their
views on this subject.
The Iowa Way.
The State Board of Medical Examiners
has notified three Iowa physicians to ap-pear
before it at the meeting of the Board
to be held in August to show cause wrhy
their certificates should not be revoked
for incompetency, in failing to recognize
and properly diagnose and report infec-tious
diseases, in consequence of which
the efforts of the State and local boards
of health to protect the people were de-feated;
the diseases were disseminated;
and lives were lost.
American Public Health Association.
Please make notice in your next issue
that the date of the next meeting of the
American Public Health Association at
Indianapolis has been changed to Octo-ber
22, 23, 24, 25, 26. The meeting of the
Section of Bacteriology and Chemistry
will be held Monday, October 22d, in the
Pathological Laboratory of the Central
Insane Hospital at Indianapolis, called
to order at 10 a. m.
The meeting of the regular Association
will open Tuesday, October 23d, 10 a. m.
in Amphitheatre of the German House.
J. N. Hurty,
Local Secretary.
Review of Diseases tor .Tune, 1900.
EIGHTY COUNTIES REPORTING.
Xinety-three counties have Superinten-dents
of Health.
Except in the case of the more con-tagious
and dangerous diseases the Super-intendent
has, as a rule, to rely upon his
own information alone, since few phy-sicians
can be induced to report cases of
non-contagious diseases to him.
Where the number of cases is not given,
or the prevalence of a disease otherwise
indicated, its mere presence in the county
is to be understood as reported.
For the month of June the following
diseases have been reported from the
counties named
:
Measles.—Alamance, 25; Ashe, 8; Ber-tie,
many; Burke, 3; Cabarrus, 9; Cald-well,
5 ; Carteret ; Cherokee, many ;
Chowan, 4; Clay, several; Columbus,
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 47
epidemic; Craven, 45; Cumberland, 5;
Dare, epidemic ; Davidson ; Franklin ;
Granville, 8; Greene, 10; Halifax, 25;
Harnett, 15; Hertford, many; Hyde, 3;
Iredell, 12; Macon, 2; Martin, 50; Meck-lenburg,
10; Nash; New Hanover. 160;
Pasquotank, 25; Pender, epidemic; Robe-son,
a few; Rockingham; Rowan, 50;
Rutherford, a few; Sampson, several;
Wake, 13; Washington, 250; Watauga, a
few—38 counties.
Whooping-cough.—Brunswick; Burke,
epidemic ; Cabarrus, many ; Carteret
;
Cherokee, many; Craven, 31; Cumber-land,
10; Franklin ; Graham, several
Granville, 10; Greene, 15; Jones, several;
McDowell, 5; Macon; Martin, 50; Nash;
New Hanover, 12; Richmond, many;
Transylvania, 5; Watauga, a few—20
counties.
Sc \klatina.—Richmond, 5.
Typhoid Fever.—Alamance, 3; Alex-ander,
1; Ashe, 1; Beaufort, 3; Burke, 5;
Cabarrus, 0; Caldwell, 4; Catawba, 1;
Chowan, 2; Clay, 2; Craven, 16; David-son,
a few; Gaston, 3; Granville, 1;
Greene, 2; Halifax; Harnett, a few; Ire-dell,
8; Jackson, 5; Jones, 2; McDowell,
3; Macon, 2; Madison, 2; Martin, 6;
Mecklenburg, 4; New Hanover, 12;
Orange, 1; Pender, 3; Polk, 1; Randolph,
5; Richmond, a few; Robeson, several;
Rockingham; Rowan, 12; Rutherford, a
few; Union, 4; Wake, 15; Warren, a few;
Wilkes; Yadkin—40 counties.
Malarial Fever.—Bladen, a few; Ca-barrus;
Caswell; Gaston; Gates, a few;
Greene, general; Halifax, general; Har-nett;
Hertford; Iredell; Jones; Lenoir;
Martin, general; Person; Randolph;
Richmond, a few ; Robeson ; Rowan ;
Sampson; Wilson—20 counties.
Malarial Fever, Pernicious.—Hert-ford,
1 ; Jones, 1.
Malarial Fever, Hemorrhagic.—Ca-barrus,
1 ; Hertford, 1.
Influenza.— Brunswick ; Cleveland ;
Randolph; Sampson; Stokes, general.
Diarrhoeal Diseases, including Dys-entery.—
Ashe, general; Bertie, general;
Bladen; Burke, general; Cabarrus; Ca-tawba;
Dare, general; Gaston, a few;
Gates; Graham; Granville; Halifax, gen-eral;
Haywood; Henderson, general; Mc-
Dowell; .Martin; Person; Polk, several;
Richmond; Robeson; Rockingham, gen-eral;
Union; Wake, general; Yadkin,
general—24 counties.
Mumps.—Martin, general; Moore, 3.
Pneumonia.—Lenoir.
Yaricella.—Caswell.
Small Pox.—Buncombe, 5; Burke, 10;
Cabarrus, 2; Caswell, 9; Craven, 10; Dur-ham,
2; Fdgecombe, 2; Gates, 1; Gran-ville,
4; Harnett, 8; Hertford, 1; Iredell,
5; Johnston, 1; Mecklenburg, 15, in
northeastern part; Moore, 14, confined to
two houses; Nash, 3; New Hanover, 7;
Randolph, 5; Rockingham, 21-19 counties.
Cholera in Chickens. — Alamance,
Graham.
Cholera in Hogs.—Bertie, Graham,
Jackson, Moore.
Distemper in Horses.—Ashe.
No diseases are reported from Chatham,
Davie, Lincoln, Mitchell, Northampton,
Pitt, Yance and Yancey.
No reports received from Alleghany,
Anson, Currituck, Duplin, Forsyth, Guil-ford,
Montgomery, Onslow, Perquimans,
Stanly, Surry, Swain and Wayne.
Summary of Mortuary Reports for
June, 1900.
(twenty towns).
Only those towns from which certified
reports are received are included.
White. CoVd. Total.
Aggregate popula-tion
86,501 59,549 146,050
Aggregate deaths... 108 89 197
Representing tem-porary
annual
death rate per
1,000 14.9 17.8 16.2
Causes of Death.
Typhoid fever 4 15 Malarial fever 2 3 5
Whooping cough... Oil Measles 2 1 3
Pneumonia 3 4 7
Consumption 7 7 14
Brain diseases 5 16 Heart diseases 6 '> 12
Neurotic diseases... 2 3 5
1 liarrhceal diseases 22 13 35
All other diseases.. 52 48 100
Accident 3 3
Yiolence 11
108 89 197
Deaths under five
years 40 28 68
Still-born - 4 4 8
48 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
Mortuary Report for
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 49
County Superintendents of Health.
Alamance Dr. T. S. Fancette.
Alexander Dr. T. F. Stevenson.
Alleghany Dr. B. C. Waddell.
Anson Dr. E. S. Ashe.
Ashe Dr. Manley Blevins.
Beaufort Dr. P. A. Nicholson.
Bertie Dr. H. V. Dnnstan.
Bladen Dr. Newton Robinson.
Brunswick Dr. J. A. McNeill.
Buncombe Dr. E. R. Morris.
Burke Dr. J. L. Laxton.
Cabarrus Dr. D. G. Caldwell.
Caldwell Dr. A. A. Kent.
Camden
Carteret Dr. F. M. Clark.
Caswell Dr. 8. A. Malloy.
Catawba Dr. Geo. H. West.
Chatham Dr. H. T. Chapin.
Cherokee Dr. J. F. Abernathy.
Chowan Dr. T. J. Hoskins.
Clay Dr. J. M. Sullivan.
Cleveland Dr. B. H. Palmer.
Columbus Dr. I. Jackson.
Craven Dr. R. DuYal Jones.
Cumberland Dr. J.YanceMcGougan.
Currituck Dr. H. M. Shaw.
Dare .Dr. W. B. Fearing.
Davidson Dr. Joel Hill.
Davie Dr. James McGuire.
Duplin Dr. F. H. Arthur.
Durham Dr. Z. T.Brooks.
Edgecombe Dr. L. L. Staton.
Forsyth Dr. John Bynum.
Franklin Dr. E. S. Foster.
Gaston Dr. J. H. Jenkins.
Gates Dr. W. 0. P. Lee.
Graham Dr. R. J. Orr.
Granville Dr. S. D. Booth.
Greene Dr. Joseph E. Grimsley.
Guilford Dr. R. L. Rierson.
Halifax Dr. I. E. Green.
Harnett Dr. O. L. Denning.
Haywood Dr. F. M. Davis.
Henderson Dr. J. G. Waldrop
Hertford Dr. John W. Tayloe.
Hyde Dr. E. H. Jones.
Iredell Dr. Henry F. Long.
Jackson Dr. Wm. Self.
Johnston Dr. L. D. Wharton.
Jones Dr. S. E. Koonce.
Lenoir Dr. W. T. Parrott.
Lincoln Dr. J. AV. Sain.
McDowell Dr. B. A. Cheek.
Macon Dr. F. L. Siler.
Madison Dr. Jas. K. Hardwicke.
Martin Dr. W. H. Harrell.
Mecklenburg Dr. C. M. Strong.
Mitchell Dr. C. E. Smith.
Montgomery Dr. M. P. Blair.
Moore Dr. Gilbert McLeod.
Nash Dr. J. P. Battle.
New Hanover Dr. W. D. McMillan.
Northampton Dr. H. W. Lewis.
Onslow Dr. E. L. Cox.
Orange Dr. C. D. Jones.
Pamlico
Pasquotank Dr. H. T. Aydlett.
Pender Dr. L. L. Ardrey.
Perquimans Dr. C. C. Winslow.
Person Dr. J. A. Wise.
Pitt Dr. C. O'H. Laughing-house.
Polk Dr. Earle Grady.
Randolph Dr. T. T. Ferree.
Richmond Dr. J. M. Ledbetter.
Robeson Dr. H. T. Pope.
Rockingham Dr. Sam Ellington.
Rowan Dr. W. L. Crump.
Rutherford Dr. W. A. Thompson.
Sampson Dr. R. E. Lee.
Scotland
Stanlv Dr. J. W. Littleton.
Stokes Dr. W. L. McCanless.
Surry Dr. John R. Woltz.
Swain Dr. R. L. Davis.
Transylvania Dr. M. M. King.
Tyrrell
Union Dr. J. E. Ashcraft.
Vance Drs. W. T. & G. Cheat-ham.
Wake Dr. J. J. L. McCullers.
AVarren Dr. T B. AVilliams.
AVashington Dr. W. H. AVard.
AVatauga Dr. E. F. Bingham.
Wayne Dr. AVilliam Spicer.
AVilkes Dr J. AV. AVhite.
AVilson Dr. AV. S. Anderson.
Yadkin Dr. B. B. Hauser.
Yancey Dr. AA
T
. B. Robertson.
BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH. 5]
[You are asked to fill out and mail one of these forms to the Superintendent of Health of your
county on or before the third of each month, that he may use it in making his report to the Secretary
of the State Board.]
Have any of the following diseases occurred in your practice during the month
just closed. If so, state number of cases.
Whooping-cough Typhoid Fever
Measles Typhus Fever
Diphtheria Yellow Fever
Scarlet Fever Cholera
Pernicious Malarial Fever Smallpox
Hemorrhagic Malarial Fever Cerebro-spinal Meningitis
What have been the prevailing diseases in your practice?
Has any epidemic occurred among domestic animals? If so, what?
What is the sanitary condition of your section, public and private?
General Remarks:
M. D.
190 -- N. C
IBTTX-.ILjIE'X.insr
OF THE
North Carolina Board of Health.
Published Monthly at the Office of the Secretary of the Board, Raleigh, X. C.
i
Geo. G. Thomas, M. D., Pres., Wilmington. C. J. O'Hagax, M. D Greenville.
S. Westray Battle, M. D...Asheville. j J. L. Nicholson, M. D Richlands.
Henry W. Lewis, M. D Jackson. Albert Anderson, M. D "Wilson.
Henry H. Dodson, M. D Milton. A. W. Shaffer, San. Eng Raleigh.
Richard H. Lewis, M. D., Secretary and Treasurer, Raleigh.
Vol. XV. AUGUST, 1900. No. 5.
Stamina.
WITH SPECIAL REFERENCE TO THE CONSUMP-TION
OF FAT FOOD FOR ITS MAINTENANCE
AND AS A PREVENTIVE OF TUBERCULOSIS.
By A. N. BfiLL, A. M., M. D.
While every observer recognizes the
progress that has been made during recent
years in the prevention of, and the reduc
tion of mortality from, tuberculosis, by
dealing with unsanitary surroundings,
the establishment of sanitaria, changes
of climate, etc., it seems to me that no
one who even approximately compre-hends
the universality of microbic life
—
and of none more than tubercle bacilli
can fail to perceive that, however much
we may be able to modify the external
relations bearing upon liability to tuber-culosis,
nevertheless every individual, no
matter where his dwelling-place, is more
or less subject to tubercle bacilli; for, be-sides
the utmost restriction of their preva-lence
by human effort, unless the indi-vidual
is possessed of an organism suffi-ciently
fortified to resist and overcome
conflict with them—for the conflict is
certain everywhere—he is liable to con-tract
tuberculosis. Indeed, every predis-posing
cause of disease is a challenge to
one's power of resistance. Every intelli-gent
person knows that the power of
resisting the ordinary exciting causes of
illness, such as sudden changes of tem-perature,
exposure to damp soil, room or
sheets, or night air with the windows
closed, depends upon one's state of health.
The power of resisting microbes as an
exciting cause of disease is no exception
Health fortified by such conditions as
the organism depends upon for its fabri-cation
and maintenance opposes itself to
all exciting causes of disease by the rela-tive
integrity, strength and vigor of all
the organs and functions of the body. A
person thus equipped, if beset by tubercle
bacilli or other m'crobes, effectually re-sists
them, devours them by oxidation
and casts them off.
Feebleness, on the contrary, though not
always appreciated and sometimes culti-vated,
indeed, by the practice of that
54 BULLETIN OF THE NORTH CAROLINA BOARD OF HEALTH.
altogether too popular fad, abstemious-ness,
is always and everywhere a prevail-ing
"predisposition" to disease; and
associated as it commonly is with inade-quate
nourishment, it is the most frequent
of all incitants to tuberculosis. Abstemi-ousness,
however, is variable in its prac-tice,
and uncertain; one may overeat and
yet abstain from some essential food
necessary for the maintenance of health.
Adequate nourishment and stamina de-pend
upon the supply of nutriment in the
kinds and proportions required by our
bodies.
By a somewhat extended observation
and careful study of the relation of tuber-culosis
to food, I have come to the con-clusion,
which it is the purpose of this
essay to vindicate, that, other conditions
being equal, tubercular diseases are preva-lent
in the inverse ratio to the use of fat
of some kind as an article of diet.
Antecedently, in persons on the verge
of pulmonary consumption, inability to
digest fat food is one of the most promi-nent
symptoms. They are afflicted with
dyspepsia, of the kind in which an acid
stomach is predominant—that kind of
dyspepsia which is the common effect of
the excessive and too exclusive use of
farinaceous food, insomuch as, in some
cases, to have created a loathing of fat
food in every form. Nevertheless, in
medical practice generally, this condition
is an indication for the use of fat food.
Cod-liver oil, emulsified or otherwise, is
almost universally the first remedy re-sorted
to and the most persistently urged.
Butter or bacon, the most digestible of all
fat foods, I have often found to be more
acceptable. Fat is the needful thing to
energize both digestion and nutrition.
And that form of it which is the most
acceptable is the best.
In this relation I am reminded of a
conversation on the subject with an old
naval colleague, the late Dr. Richard
McSherry, of Baltimore, some thirty odd
years ago. He related a case then but
recently under his care, in substance as
follows:
A much emaciated German shoe-maker
with pronounced phthisis and a particu-larly
rebellious stomach, had been an
office patient for several months. He
had tried various ways to render cod-liver
oil acceptable, but with discouraging re-sults.
The patient was evidently losing
ground and the intervals between his
calls increased until they had ceased alto-gether;
his condition was such, at his last
call, as to leave but one inference. About
two years had elapsed, when, on respond-ing
to an e